Provider Demographics
NPI:1962953745
Name:MCCOY, STACY M (LPC; LCPC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LPC; LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 RIDGE PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5641
Mailing Address - Country:US
Mailing Address - Phone:202-907-1522
Mailing Address - Fax:
Practice Address - Street 1:1436 RIDGE PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5641
Practice Address - Country:US
Practice Address - Phone:202-907-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6642101YP2500X
DCPRC14826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional