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Individual

STACY TATIANNA MEDINA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA.ED, LPC, NCC

Contact information

Practice address
2001 ROUTE 37 E, TOMS RIVER, NJ 08753-7168
(732) 288-9322
(732) 288-9264
Mailing address
23 GIBRALTAR CT, BARNEGAT, NJ 08005-2518
(910) 258-9624

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
37PC01037400
NJ
101YM0800X
Mental Health Counselor
37PC01037400
NJ
101YP2500X
Professional Counselor
Primary
37PC01037400
NJ

Other

Enumeration date
12/19/2024
Last updated
12/31/2024
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