Provider Demographics
NPI:1285805762
Name:EGGSWARE, STACY D'LYNN (MC, LPC, LCMHC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:D'LYNN
Last Name:EGGSWARE
Suffix:
Gender:F
Credentials:MC, LPC, LCMHC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:D'LYNN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC, LPC
Mailing Address - Street 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2870
Mailing Address - Country:US
Mailing Address - Phone:802-494-4040
Mailing Address - Fax:
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2870
Practice Address - Country:US
Practice Address - Phone:802-494-4040
Practice Address - Fax:602-491-2119
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health