Provider Demographics
NPI:1063024032
Name:FLANAGAN, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 SE BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6000
Mailing Address - Country:US
Mailing Address - Phone:910-725-0702
Mailing Address - Fax:910-246-1601
Practice Address - Street 1:375 SE BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6000
Practice Address - Country:US
Practice Address - Phone:910-725-0702
Practice Address - Fax:910-246-1601
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician