Stacie M Medlin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C008329 Issued in NC

Practice address

114 N River St
Jarvisburg, NC 27947-9522

Phone

(252) 578-1986

Fax

(252) 537-2273

NPI assigned

Nov 2, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Candm Behavioral Health, PLLCGroup PAC ID 5991933343, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• C&M Behavioral Health, PLLC

  • Community/Behavioral Health Agency
  • Roanoke Rapids, NC
  • NPI 1801222070
  Medicare reassignment Care Compare group Authorized official
• Premier Family Health Care Services, LLC

  • Case Management Agency
  • Roanoke Rapids, NC
  • NPI 1356363493
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1013293182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 HIGHWAY 158",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "27870",
            "telephone_number": "252-578-2273",
            "fax_number": "252-537-2278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N RIVER ST",
            "city": "JARVISBURG",
            "state": "NC",
            "postal_code": "279479522",
            "telephone_number": "252-578-1986",
            "fax_number": "252-537-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLIN",
        "first_name": "STACIE",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-02",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Nicole Crocker, FNP-C
• Gaston Family Health Services, Inc.
• Grandy Family Medicine PC
• Madeline Kiousis
• Mane & Taill Therapeutic Horsemanship Academy
• James Lee Owens, MD
• Jessica Penson-Heyder, LCSW
• Jane Arlene Randall, PNP
• Karen Tejano, MSCP, LCMHC, LCAS

• Clinical Social Worker in Jarvisburg, NC
• Providers in Jarvisburg, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.