| Entity Name: | STACEY DAVIS, PH.D., LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Feb 2015 (10 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L15000031547 |
| Address: | 11 NW 33RD COURT, GAINESVILLE, FL, 32607 |
| Mail Address: | 11 NW 33RD COURT, GAINESVILLE, FL, 32607 |
| ZIP code: | 32607 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851787360 | 2015-04-10 | 2015-04-10 | 11 NW 33RD CT, GAINESVILLE, FL, 326072552, US | 11 NW 33RD CT, GAINESVILLE, FL, 326072552, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 352-870-8173 |
Authorized person
| Name | DR. STACEY DAVIS |
| Role | LICENSED PSYCHOLOGIST/OWNER |
| Phone | 3528708173 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY 7649 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA DEPARTMENT OF HEALTH |
| Number | PY 7649 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIS STACEY | Agent | 11 NW 33RD COURT, GAINESVILLE, FL, 32607 |
| Name | Role | Address |
|---|---|---|
| DAVIS STACEY PH.D. | Authorized Member | 11 NW 33RD COURT, GAINESVILLE, FL, 32607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2015-02-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
