Individual
STACY TATIANNA MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA.ED, LPC, NCC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
37PC01037400
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00423000
NJ
101YM0800X
Mental Health Counselor
37PC01037400
NJ
101YP2500X
Professional Counselor
Primary
37PC01037400
NJ
Other
Enumeration date
12/19/2024
Last updated
08/03/2026
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