Stacy, John Leroy

Stacy, John Leroy is an sole proprietor health care provider with primary practice located at 1216 Granby St Ste 211 , Norfolk VA 23510-2622. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is his primary health care specialty. Stacy, John Leroy can be contacted via phone (757) 632-0343.

Contact Information

Primary practice address
1216 Granby St Ste 211 Norfolk VA 23510-2622
Phone: (757) 632-0343
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 0710102681 Virginia
Behavioral Health & Social Service Providers / Professional 101YP2500X 0701006465 Virginia

Profile Details

NPI number 1306182795
LBN Legal business name Stacy, John Leroy
Credentials CSAC, LPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2012
Last updated Apr 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306182795 NPPES
Virginia MEDICAID 1245936616

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