Provider Demographics
NPI:1306182795
Name:STACY, JOHN LEROY JR (CSAC, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEROY
Last Name:STACY
Suffix:JR
Gender:M
Credentials:CSAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GRANBY ST STE 221
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2568
Mailing Address - Country:US
Mailing Address - Phone:757-632-0343
Mailing Address - Fax:
Practice Address - Street 1:900 GRANBY ST STE 221
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2568
Practice Address - Country:US
Practice Address - Phone:757-632-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102681101YA0400X
VA0701006465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)