Provider Demographics
NPI:1992994727
Name:MORRIS, STACYLEE ANN (MA LADC CCS)
Entity type:Individual
Prefix:
First Name:STACYLEE
Middle Name:ANN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MA LADC CCS
Other - Prefix:
Other - First Name:STACYLEE
Other - Middle Name:ANN
Other - Last Name:KNOBLACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7172
Mailing Address - Country:US
Mailing Address - Phone:207-784-0922
Mailing Address - Fax:
Practice Address - Street 1:4 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7172
Practice Address - Country:US
Practice Address - Phone:207-784-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)