Active NPI
Stacie Camp Bennett, MA, LPC
- Professional Counselor
- Shelby, NC
National Provider Identifier
1902955503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3813
- Practice address
- 809 N Lafayette St
Suite a
Shelby, NC 28150-3978 - Phone
- (704) 301-8093
- Fax
- (704) 301-8093
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3813 | NC | Primary |
Addresses
Primary practice location
809 N Lafayette St
Suite a
Shelby, NC 28150-3978
Mailing address
449 Paul H. Beam Road
Cherryville, NC 28021
Phone (704) 301-8093
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6102552 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3813 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434585600000",
"number": "1902955503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "449 PAUL H. BEAM ROAD",
"city": "CHERRYVILLE",
"state": "NC",
"postal_code": "28021",
"telephone_number": "704-301-8093",
"fax_number": "704-301-8093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "809 N LAFAYETTE ST",
"address_2": "SUITE A",
"city": "SHELBY",
"state": "NC",
"postal_code": "281503978",
"telephone_number": "704-301-8093",
"fax_number": "704-301-8093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "STACIE",
"middle_name": "CAMP",
"name_prefix": "Mrs.",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2015-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "3813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102552",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelby, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.