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NPI Code Detail

MEDICARE: STICK & STAY PREVENTION, INC

MEDICARE: STICK & STAY PREVENTION, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2175T00000XPeer Specialist
3251B00000XCase Management Agency
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
5251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1548906506
Entity Type Code : Organization
Provider Name (Legal Business Name) : STICK & STAY PREVENTION, INC
Provider Business Mailing Address
First Line : 1812 LIBERTY ST
Second Line :
City : DURHAM
State : NC
Zip : 27703-2271
Country : US
Telephone Number : 919-384-5758
Fax Number :
Provider Business Practice Location Address
First Line : 1812 LIBERTY ST
Second Line :
City : DURHAM
State : NC
Zip : 27703-2271
Country : US
Telephone Number : 919-384-5758
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : SANDRA DENISE LASSITER
Credential :
Telephone Number : 919-384-5758
Provider Enumeration Date : 05/11/2022
Last Update Date : 06/22/2022

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Directions to “STICK & STAY PREVENTION, INC ” Practice Location

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