Stacey Whitehead

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Practice address

355 Beckwith Ave
Clayton, NC 27527-4258

Phone

(919) 538-8945

NPI assigned

Jul 14, 2021

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• The Bear Enterprise, LLC

  • Developmentally Disabled Services Day Training Agency
  • Clayton, NC
  • NPI 1053159632
  NPD Authorized official
• The Bear Enterprise, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Clayton, NC
  • NPI 1912670266

  Residential Treatment Facility, Emotionally Disturbed Children

  NPD Authorized official

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1457923971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LOGGER CT STE A102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276098506",
            "telephone_number": "919-538-8945",
            "fax_number": "919-803-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BECKWITH AVE",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275274258",
            "telephone_number": "919-538-8945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITEHEAD",
        "first_name": "STACEY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katena White
• Michael R. White, DPT
• Tekia Nicole White
• Whitney Norton White
• Rene Whitehead, MS, LCAS-A
• Wendy Whitfield
• Carolyn Barnnette Whitley
• Marika Patrycja Widmann, DNP
• Ashante Wiggins
• Vincent Kyle Wiggins, AGACNP

• Emotionally Disturbed Childrens' Residential Treatment Facility in Clayton, NC
• Providers in Clayton, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.