Healthcare Provider Details

I. General information

NPI: 1134206485
Provider Name (Legal Business Name): STACIE ANN RATLIFF LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date: 07/07/2026
Reactivation Date: 08/17/2026

III. Provider practice location address

102 W CHURCH ST STE 210
FREDERICK MD
21701-5411
US

IV. Provider business mailing address

23806 BENNETT CHASE DR
CLARKSBURG MD
20871-5316
US

V. Phone/Fax

Practice location:
  • Phone: 301-639-4180
  • Fax:
Mailing address:
  • Phone: 301-639-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: