Provider Demographics
NPI:1538273081
Name:BUSHEY, STACY RAE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RAE
Last Name:BUSHEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MARKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 OLD VIRGINIA BEACH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-5564
Mailing Address - Country:US
Mailing Address - Phone:757-422-2118
Mailing Address - Fax:757-422-2388
Practice Address - Street 1:1008 OLD VIRGINIA BEACH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5564
Practice Address - Country:US
Practice Address - Phone:757-422-2118
Practice Address - Fax:757-422-2388
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004428104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker