| Doctor Name: | STACY RENEE BLANKENSHIP |
| NPI Number: | 1043556541 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C008411 |
| Business Practice Address: | 350 E Holding Ave Wake Forest, NC - 275872904 |
| Business Phone Number: | 9192639365 |
| Business Fax Number: | 9195524283 |
| Mailing Address: | 350 Pee Dee Ave, ALBEMARLE |
| State: | NC |
| Postal Code: | 280014932 |
| Phone Number: | 9192639365 |
| Fax Number: | 9194351035 |
| NPI Enumeration Date: | 01/02/2013 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C008411 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |