Provider Demographics
NPI:1811463342
Name:BAKER, STACY LACHELL (NCC, LPC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LACHELL
Last Name:BAKER
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 LYCKAN PKWY STE 4008
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2539
Mailing Address - Country:US
Mailing Address - Phone:919-213-0225
Mailing Address - Fax:919-869-1467
Practice Address - Street 1:3500 WESTGATE DR STE 303
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2534
Practice Address - Country:US
Practice Address - Phone:919-213-0225
Practice Address - Fax:919-869-1467
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14363101YM0800X, 101YM0800X, 101YP2500X
NCA14363101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional