Provider Demographics
NPI:1902280969
Name:DONALDSON, STACY LEIGH
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEIGH
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LEIGH
Other - Last Name:MAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 TOWN CENTER PKWY UNIT 34
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2920
Mailing Address - Country:US
Mailing Address - Phone:909-938-6360
Mailing Address - Fax:
Practice Address - Street 1:1903 BUNBURY CT
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-9703
Practice Address - Country:US
Practice Address - Phone:909-377-1455
Practice Address - Fax:909-377-1456
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist