Provider Demographics
NPI:1649301573
Name:INMAN, STACEY HEPLER (MA, LCAS, CCS)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:HEPLER
Last Name:INMAN
Suffix:
Gender:F
Credentials:MA, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3276
Mailing Address - Country:US
Mailing Address - Phone:336-561-1268
Mailing Address - Fax:
Practice Address - Street 1:4035 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3276
Practice Address - Country:US
Practice Address - Phone:336-561-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110522Medicaid
NC6112171Medicaid