MEDICARE: MRS. STACEY HEPLER INMAN M.A., L.C.A.S, C.C.S

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
1	101YP2500X	Professional Counselor	514	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649301573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACEY HEPLER INMAN M.A., L.C.A.S, C.C.S

Provider Business Mailing Address
First Line	:	4035 UNIVERSITY PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3276
Country	:	US
Telephone Number	:	336-561-1268
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 UNIVERSITY PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3276
Country	:	US
Telephone Number	:	336-561-1268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	06/03/2011

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