Provider Demographics
NPI:1730544958
Name:POCEVICH, STACEY ANN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:POCEVICH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 6817
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-926-1246
Mailing Address - Fax:
Practice Address - Street 1:13 E PARK BLVD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-926-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2020-02-03
Deactivation Date:2017-12-04
Deactivation Code:
Reactivation Date:2017-12-11
Provider Licenses
StateLicense IDTaxonomies
IL180.011294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health