Provider Demographics
NPI:1457982498
Name:STUMP, DARSEY (LPCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:DARSEY
Middle Name:
Last Name:STUMP
Suffix:
Gender:F
Credentials:LPCC-S, LICDC
Other - Prefix:
Other - First Name:DARSEY
Other - Middle Name:
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5142 PROVIDENCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9155
Mailing Address - Country:US
Mailing Address - Phone:910-650-8675
Mailing Address - Fax:
Practice Address - Street 1:422 W LOVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2322
Practice Address - Country:US
Practice Address - Phone:513-334-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004729A101Y00000X
OHLICDC.161919101YA0400X
OHE.2102642-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty