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Individual
STACIA MARIE NISSEN
Active
Individual
STACIA MARIE NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC-MH, LAC, NCC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
08111384
SD
101YM0800X
Mental Health Counselor
Primary
LPC-MH20292
SD
Other
Enumeration date
12/09/2008
Last updated
03/30/2018
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