Individual
MR. JOHN LEROY STACY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC, LPC
Contact information
Practice address
1216 GRANBY ST STE 211, NORFOLK, VA 23510-2622
(757) 632-0343
Mailing address
1216 GRANBY ST STE 211, NORFOLK, VA 23510-2622
(757) 632-0343
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102681
VA
101YP2500X
Professional Counselor
Primary
0701006465
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245936616
—
VA
Enumeration date
12/12/2012
Last updated
04/17/2024
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