Provider Demographics
NPI:1467768481
Name:BLISS, STACIE (LPC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BLISS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FOX VIEW PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7223
Mailing Address - Country:US
Mailing Address - Phone:720-498-0836
Mailing Address - Fax:
Practice Address - Street 1:210 FOX VIEW PL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7223
Practice Address - Country:US
Practice Address - Phone:720-498-0836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional