Provider Demographics
NPI:1487807095
Name:STACEY, WILLIAM DELANO (LLMSW, CAAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DELANO
Last Name:STACEY
Suffix:
Gender:M
Credentials:LLMSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4737
Mailing Address - Country:US
Mailing Address - Phone:616-776-0891
Mailing Address - Fax:616-233-0718
Practice Address - Street 1:822 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1402
Practice Address - Country:US
Practice Address - Phone:616-776-0891
Practice Address - Fax:616-233-0718
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical