Individual
STACEY MARIE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW #253840
Contact information
Practice address
3109 MCMAHAN BLVD, LOUISVILLE, KY 40220-2240
(502) 418-2825
Mailing address
3109 MCMAHAN BLVD, LOUISVILLE, KY 40220-2240
(502) 418-2825
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
253840
KY
Other
Enumeration date
11/07/2014
Last updated
12/02/2019
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