Provider Demographics
NPI:1417164344
Name:SALMON, STACY LACOLE (MA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LACOLE
Last Name:SALMON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:LACOLE
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2553 WILLOW POND LN SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0030
Mailing Address - Country:US
Mailing Address - Phone:980-888-3711
Mailing Address - Fax:
Practice Address - Street 1:3812 DRY BROOK RD
Practice Address - Street 2:APT I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0765
Practice Address - Country:US
Practice Address - Phone:423-833-9476
Practice Address - Fax:423-833-9476
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10113101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health