Provider Demographics
NPI:1932693876
Name:HARLAN, STACIA MARIE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:MARIE
Last Name:HARLAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 N SPENCE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4354
Mailing Address - Country:US
Mailing Address - Phone:919-581-7072
Mailing Address - Fax:919-288-1879
Practice Address - Street 1:696 N SPENCE AVE STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4354
Practice Address - Country:US
Practice Address - Phone:919-581-7072
Practice Address - Fax:919-288-1879
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health