Stacy Blalock, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC011063 Issued in GA

Practice address

1944 Brannan Rd
McDonough, GA 30253-4310

Phone

(678) 289-6981

Fax

(678) 289-6983

NPI assigned

Aug 27, 2019

Sex

Female

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

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.

• Eagle'S Landing Christian Counseling Center, Inc.

  • Professional Counselor
  • McDonough, GA
  • NPI 1093955205

  Professional

  NPD

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1891343596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 RIVEREDGE DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524141",
            "telephone_number": "770-605-5953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1944 BRANNAN RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534310",
            "telephone_number": "678-289-6981",
            "fax_number": "678-289-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "STACY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC011063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silvana M Bishop, DPT
• Nicole Bittle-Obi
• BJ'S Wholesale Club Inc.
• BJS Wholesale Club Inc
• Janel Blair, DPT
• Erica Blanding
• Zakiesha Chamale Blanks, DOULA
• Leah C. Blanton, M.D.
• Nicole Blanton
• Gabrielle N. Blaylock, PA-C, ATC

• Professional Counselor in McDonough, GA
• Providers in McDonough, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.