Provider Demographics
NPI:1831519180
Name:WHITEHEAD, STACIE (LCMHC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COHEN CT
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-0913
Mailing Address - Country:US
Mailing Address - Phone:614-208-0790
Mailing Address - Fax:614-208-0790
Practice Address - Street 1:35 COHEN CT
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-0913
Practice Address - Country:US
Practice Address - Phone:614-208-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional