Organization
FAMILY LEGACY MENTAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA DYAN STACEY B.S. Q.P (CEO)
(919) 834-2000
Entity
Organization
Contact information
Practice address
1007 BROAD ST, DURHAM, NC 27705-4143
(919) 834-2000
(919) 834-2001
Mailing address
1011 SCHAUB DR, SUITE 200, RALEIGH, NC 27606-1862
(919) 834-2000
(919) 834-2001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
6102775
NC
103TC0700X
Clinical Psychologist
6107485
NC
103TC1900X
Counseling Psychologist
6001168
NC
106H00000X
Marriage & Family Therapist
6105171
NC
2080A0000X
Pediatric Adolescent Medicine Physician
9300596
NC
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5913953
—
NC
05
—
6006506
—
NC
05
—
8302411
—
NC
05
—
8302925
—
NC
Enumeration date
04/02/2008
Last updated
06/18/2014
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