Provider Demographics
NPI:1043690670
Name:CONNOR, STACY (LCSW, LCAS, CCS)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 LEE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-5801
Mailing Address - Country:US
Mailing Address - Phone:252-229-9665
Mailing Address - Fax:
Practice Address - Street 1:1106 LEE LANDING RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5801
Practice Address - Country:US
Practice Address - Phone:252-229-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO108171041C0700X
NC21717101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)