Provider Demographics
NPI:1336316033
Name:LUCIUS, STACIE L
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:LUCIUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EPPING RD STE 203
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-1550
Mailing Address - Country:US
Mailing Address - Phone:603-828-7015
Mailing Address - Fax:
Practice Address - Street 1:137 EPPING RD STE 203
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-1550
Practice Address - Country:US
Practice Address - Phone:603-828-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0571101YA0400X
MA10003963101YM0800X
NH812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH3227Medicare PIN