| Doctor Name: | STACI POE |
| NPI Number: | 1003234972 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 178.009748 |
| Business Practice Address: | 44 E Main St Ste 406 Champaign, IL - 618203636 |
| Business Phone Number: | 2173989066 |
| Business Fax Number: | 2173989077 |
| Mailing Address: | 44 E Main St, Ste 406 CHAMPAIGN |
| State: | IL |
| Postal Code: | 618203636 |
| Phone Number: | 2173989066 |
| Fax Number: | 2173989077 |
| NPI Enumeration Date: | 03/28/2014 |
| NPI Last Update Date: | 03/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178.009748 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |