Provider Demographics
NPI:1447863493
Name:CENTERS, STACIE ELIZABETH
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:ELIZABETH
Last Name:CENTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 MEETING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EASTVIEW
Mailing Address - State:KY
Mailing Address - Zip Code:42732-9751
Mailing Address - Country:US
Mailing Address - Phone:270-505-9942
Mailing Address - Fax:
Practice Address - Street 1:3212 MEETING CREEK RD
Practice Address - Street 2:
Practice Address - City:EASTVIEW
Practice Address - State:KY
Practice Address - Zip Code:42732-9751
Practice Address - Country:US
Practice Address - Phone:270-505-9942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator