Healthcare Provider Details

I. General information

NPI: 1568077477
Provider Name (Legal Business Name): STACIE SEXTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 NICHOLASVILLE RD APT 1109
LEXINGTON KY
40503-1181
US

IV. Provider business mailing address

1435 NICHOLASVILLE RD APT 1109
LEXINGTON KY
40503-1181
US

V. Phone/Fax

Practice location:
  • Phone: 859-536-1014
  • Fax:
Mailing address:
  • Phone: 859-536-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: