Healthcare Provider Details

I. General information

NPI: 1578110383
Provider Name (Legal Business Name): STACY M HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 09/24/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RYANS LN
CLAYTON NC
27520-5549
US

IV. Provider business mailing address

7283 NC HWY 42 W STE 102 # 161
RALEIGH NC
27603-7530
US

V. Phone/Fax

Practice location:
  • Phone: 828-360-1620
  • Fax:
Mailing address:
  • Phone: 828-360-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12173A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: