Healthcare Provider Details

I. General information

NPI: 1235871682
Provider Name (Legal Business Name): STACIE DANIELLE MCGHEE MACM, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7611
US

IV. Provider business mailing address

5511 VIRGINIA WAY STE 300
BRENTWOOD TN
37027-7611
US

V. Phone/Fax

Practice location:
  • Phone: 615-994-1000
  • Fax: 615-994-0100
Mailing address:
  • Phone: 615-994-1000
  • Fax: 615-994-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1488
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: