St. Mark'S Manor Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MHL-092-399 Issued in NC

Legal business name

ST. MARK'S MANOR INC

Practice address

3733 Heritage Meadow Lane
Holly Springs, NC 27540

Phone

(919) 363-5311

Fax

(919) 363-5312

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Priscilla C Petty

Title

Administrator

Phone

(919) 363-5311

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629125109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1057",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275401057",
            "telephone_number": "919-363-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3733 HERITAGE MEADOW LANE",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "27540",
            "telephone_number": "919-363-5311",
            "fax_number": "919-363-5312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARK'S MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-363-5311",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "MHL-092-399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lauren Watson Stalte, MS CCC-SLP

• Mental Health Counselor in Holly Springs, NC
• Providers in Holly Springs, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.