Provider Demographics
NPI:1184103525
Name:EPPS, STACY RENNE (CCDC CCJS CDP AT CAD)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RENNE
Last Name:EPPS
Suffix:
Gender:F
Credentials:CCDC CCJS CDP AT CAD
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Mailing Address - Street 1:STACY RENNE EPPS DE STEFANO
Mailing Address - Street 2:10559 SOUTH PROSPECT AVE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2923
Mailing Address - Country:US
Mailing Address - Phone:773-339-5746
Mailing Address - Fax:773-238-3272
Practice Address - Street 1:10559 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2923
Practice Address - Country:US
Practice Address - Phone:773-339-5746
Practice Address - Fax:773-238-3278
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15175101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor