Provider Demographics
NPI:1679188338
Name:STACIE RALTIFF, LCSW-C
Entity type:Organization
Organization Name:STACIE RALTIFF, LCSW-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-639-4180
Mailing Address - Street 1:23806 BENNETT CHASE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-5316
Mailing Address - Country:US
Mailing Address - Phone:301-639-4180
Mailing Address - Fax:
Practice Address - Street 1:23806 BENNETT CHASE DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-5316
Practice Address - Country:US
Practice Address - Phone:301-639-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty