Provider Demographics
NPI:1598499741
Name:LAYNE, STACEY LEANNA (BCBA)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LEANNA
Last Name:LAYNE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:GEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1698 HIGHWAY 160 W STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8035
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:
Practice Address - Street 1:1698 HIGHWAY 160 W STE 240
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8035
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-60323103K00000X
NC2362103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst