Provider Demographics
NPI:1043556541
Name:BLANKENSHIP, STACY RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RENEE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 W COTTON GIN DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4585
Mailing Address - Country:US
Mailing Address - Phone:919-946-0349
Mailing Address - Fax:
Practice Address - Street 1:206 HIGH HOUSE RD STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8496
Practice Address - Country:US
Practice Address - Phone:919-678-0124
Practice Address - Fax:919-230-0127
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0084111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC008411OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LISCENSURE BOARD