Healthcare Provider Details

I. General information

NPI: 1689897928
Provider Name (Legal Business Name): STACY STODDARD, LCMFT AND ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 PROVIDENCE RD
TOWSON MD
21286-5503
US

IV. Provider business mailing address

602 PROVIDENCE RD
TOWSON MD
21286-5503
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-7443
  • Fax: 410-583-0711
Mailing address:
  • Phone: 410-583-7443
  • Fax: 410-583-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierKM48
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST BCBS

VIII. Authorized Official

Name: STACY STODDARD
Title or Position: OWNER
Credential:
Phone: 443-221-0366