Provider Demographics
NPI:1043390057
Name:STALLS, PAMELA (LMFT, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:STALLS
Suffix:
Gender:F
Credentials:LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 LODER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4339
Mailing Address - Country:US
Mailing Address - Phone:910-796-1515
Mailing Address - Fax:
Practice Address - Street 1:261 LODER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-4339
Practice Address - Country:US
Practice Address - Phone:910-796-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC907101YA0400X
NC881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist