Provider Demographics
NPI:1215473509
Name:GOBINS, STACEY SUZANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:SUZANNE
Last Name:GOBINS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 MARKET ST UNIT 10233
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0070
Mailing Address - Country:US
Mailing Address - Phone:845-416-0962
Mailing Address - Fax:
Practice Address - Street 1:624 WILD DUNES CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8344
Practice Address - Country:US
Practice Address - Phone:845-416-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22674101YA0400X
NC16257101YM0800X
NY006001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)