NPIMap

Organization Active NPI

Family Legacy Mental Health Services Inc

  • Community/Behavioral Health Agency
  • Durham, NC
National Provider Identifier
1932371655
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
FAMILY LEGACY MENTAL HEALTH SERVICES INC
Practice address
1007 Broad St
Durham, NC 27705-4143
Phone
(919) 834-2000
Fax
(919) 834-2001
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

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

Authorized official

Name
Lisa Dyan Stacey, B.S. Q.P
Title
Ceo
Phone
(919) 834-2000

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 6102775 NC
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 6107485 NC
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X 6001168 NC
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 6105171 NC
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 9300596 NC
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

1007 Broad St
Durham, NC 27705-4143

Mailing address

1011 Schaub Dr
Suite 200
Raleigh, NC 27606-1862
Phone (919) 834-2000

Other identifiers 4

IdentifierTypeStateIssuer
8302925MedicaidNC
8302411MedicaidNC
5913953MedicaidNC
6006506MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Family Legacy Mental Health Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1932371655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 SCHAUB DR",
            "address_2": "SUITE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276061862",
            "telephone_number": "919-834-2000",
            "fax_number": "919-834-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 BROAD ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054143",
            "telephone_number": "919-834-2000",
            "fax_number": "919-834-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LEGACY MENTAL HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "STACEY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-834-2000",
        "authorized_official_credential": "B.S. Q.P"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "6102775",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "6107485",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "NC",
            "license": "6001168",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "6105171",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NC",
            "license": "9300596",
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302925",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302411",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5913953",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006506",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.