Provider Demographics
NPI:1588682751
Name:FORREST, STACIE CREECH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:CREECH
Last Name:FORREST
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 1:6050 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8601
Mailing Address - Country:US
Mailing Address - Phone:919-870-8699
Mailing Address - Fax:919-870-8544
Practice Address - Street 1:6050 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8601
Practice Address - Country:US
Practice Address - Phone:919-870-8699
Practice Address - Fax:919-870-8544
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102448Medicaid