Active NPI
Stacy Denise Brink, PSY.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1114175338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4026
- Practice address
- 5203 Sharon Rd
Charlotte, NC 28210-4721 - Phone
- (704) 554-9900
- NPI assigned
- Aug 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4026 | NC | Primary |
Addresses
Primary practice location
5203 Sharon Rd
Charlotte, NC 28210-4721
Mailing address
2336 Shenandoah Ave
Charlotte, NC 28205-6026
Phone (980) 422-4016
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4026 | NC | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presbyterian Samaritan Counseling Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Charlotte, NC
- NPI 1871679464
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300147200000",
"number": "1114175338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2336 SHENANDOAH AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282056026",
"telephone_number": "980-422-4016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5203 SHARON RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282104721",
"telephone_number": "704-554-9900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRINK",
"first_name": "STACY",
"middle_name": "DENISE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-29",
"last_updated": "2011-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "4026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.