Provider Demographics
NPI:1053575530
Name:SAVAGE, STACY A (MS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FREEMONT TURN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4782
Mailing Address - Country:US
Mailing Address - Phone:386-597-2904
Mailing Address - Fax:386-597-2903
Practice Address - Street 1:381 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4781
Practice Address - Country:US
Practice Address - Phone:386-597-2904
Practice Address - Fax:386-597-2903
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health