Provider Demographics
NPI:1114268869
Name:CRAIG, STACEY E (LCSW/LICSW)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:E
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LCSW/LICSW
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:CRAIG
Other - Last Name:RIBERDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW/LICSW
Mailing Address - Street 1:5613 DURALEIGH RD STE 161
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2709
Mailing Address - Country:US
Mailing Address - Phone:919-951-8139
Mailing Address - Fax:
Practice Address - Street 1:5613 DURALEIGH RD STE 161
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2709
Practice Address - Country:US
Practice Address - Phone:919-951-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1188781041C0700X
NCC0119461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical