John Leroy Stacy Jr., CSAC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701006465 Issued in VA

Practice address

1216 Granby St Ste 211
Norfolk, VA 23510-2622

Phone

(757) 632-0343

NPI assigned

Dec 12, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

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

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Redefine Therapy, LLC

  • Professional Counselor
  • Norfolk, VA
  • NPI 1245936616
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1306182795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 GRANBY ST STE 211",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102622",
            "telephone_number": "757-632-0343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 GRANBY ST STE 211",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102622",
            "telephone_number": "757-632-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "JOHN",
        "middle_name": "LEROY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CSAC, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-12-12",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710102681",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701006465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245936616",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Marys Home for Disabled Children
• Harvey Sheldon St. Clair, M.D.
• Carl Raphael St. Remy, M.D.
• Laura M Stacey, M.ED., BCBA, LBA
• Savannah B Stacey
• Anthony Todd Stainback, RPH
• Eric William Staley, NAVY IDC
• Chakia Nicole Stallings, LPC
• Chanel Stallings
• Valerie Stallings, M.D.

• Professional Counselor in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.