Perry Glenn Stanley, EDD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6173 Issued in NC

Practice address

3825 Market St Ste 4
Wilmington, NC 28403-1426

Phone

(910) 777-5575

Fax

(910) 777-5273

NPI assigned

Oct 3, 2006

Last updated

Oct 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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 WV, NC2 enrollments

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 2

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wilmington Mental Health PLLCGroup PAC ID 8325439201, 11 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wilmington Mental Health, PLLC

  dba Wilmington Mental Health

  • Multi-Specialty Clinic/Center
  • Wilmington, NC
  • NPI 1396206330
  Medicare reassignment Care Compare group NPD
• Northwood Health Systems Inc

  • Community/Behavioral Health Agency
  • Wheeling, WV
  • NPI 1447473475
  Medicare reassignment
• Lifesource of North Carolina

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811286156
  NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288
  NPD
• Family Connections

  • Mental Health Counselor
  • Weirton, WV
  • NPI 1033216247
  NPD (past)
• Family Connections, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Colliers, WV
  • NPI 1366846016
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1740374438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 MARKET ST STE 4",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031426",
            "telephone_number": "910-777-5575",
            "fax_number": "910-777-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 MARKET ST STE 4",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031426",
            "telephone_number": "910-777-5575",
            "fax_number": "910-777-5273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 Eoff Street",
            "address_purpose": "LOCATION",
            "city": "Wheeling",
            "state": "WV",
            "postal_code": "26003",
            "country_code": "US",
            "telephone_number": "304-234-3570 x3276",
            "fax_number": "304-234-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANLEY",
        "first_name": "PERRY",
        "middle_name": "GLENN",
        "credential": "EDD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WV",
            "license": "596",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0164395000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alfred Ryan Stanley, DDS
• Angela D. Stanley, FNP
• John Herbert Stanley Jr., M.D.
• Lynne Marie Stanley, MSW, LCSW, ACSW, CTT
• Michelle Stanley, MSW, LCSW, LCAS
• Chelsea Stant, RD, LDN
• Brittany Stanton, LCMHCA
• Nicholas R Stanwick, PA-C
• Tabitha Brook Staradumsky, PA-C
• Shelby Manuel Starbuck

• Psychologist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.