Individual
MR. STACEY WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
355 BECKWITH AVE, CLAYTON, NC 27527-4258
(919) 538-8945
Mailing address
1100 LOGGER CT STE A102, RALEIGH, NC 27609-8506
(919) 538-8945
(919) 803-2808
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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