Provider Demographics
NPI:1215052949
Name:STINCHCOMB, STACY A (LCSW-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:STINCHCOMB
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 WEST ST STE 216
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3607
Mailing Address - Country:US
Mailing Address - Phone:410-878-3337
Mailing Address - Fax:410-656-1601
Practice Address - Street 1:1125 WEST ST STE 216
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3607
Practice Address - Country:US
Practice Address - Phone:410-878-3337
Practice Address - Fax:410-656-1601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD190421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19042OtherLCSW-C