Individual
STACEY GRACE WILLSON
Active
Individual
STACEY GRACE WILLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
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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