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Individual

STACEY GRACE WILLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
200 N LAKEPOINTE DR, LAFAYETTE, LA 70506-6431
(337) 412-8048
Mailing address
200 N LAKEPOINTE DR, LAFAYETTE, LA 70506-6431
(337) 412-8048

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3156
LA
1041C0700X
Clinical Social Worker
37976
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
37976
STATE LICENSE
TX
Enumeration date
05/05/2006
Last updated
07/08/2007
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