Provider Demographics
NPI:1487094249
Name:MCMANUS, STACEY (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MICHAEL CIR NE
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-7617
Mailing Address - Country:US
Mailing Address - Phone:256-630-3340
Mailing Address - Fax:
Practice Address - Street 1:14 MICHAEL CIR NE
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-7617
Practice Address - Country:US
Practice Address - Phone:256-630-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3981C1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health