Provider Demographics
NPI:1720109812
Name:STAKELY, CHRISTINA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:STAKELY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7511
Mailing Address - Country:US
Mailing Address - Phone:910-799-1071
Mailing Address - Fax:910-799-3313
Practice Address - Street 1:2734 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-799-1071
Practice Address - Fax:910-799-3313
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105134Medicaid