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General NPI Number Information
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NPI Number | 1831693829
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Entity Type | Individual
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Provider Name | STACEY SHERRIE SEALS LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 06/20/2020
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Provider Practice Location Address
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Address Line | 612 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-4680
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Country | US
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Telephone | 330-331-9955
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Fax |
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Provider Business Mailing Address
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Address Line | 15010 S RAVINIA AVE STE 15
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City | ORLAND PARK
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State | IL
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Zip | 60462-5353
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Country | US
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Telephone | 708-364-0580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180012959
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License Number State | IL
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