Provider Demographics
NPI:1083392617
Name:STUMBAUGH, ALLYSON HUNTER (LCSW-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:HUNTER
Last Name:STUMBAUGH
Suffix:
Gender:F
Credentials:LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BECK ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-5430
Mailing Address - Country:US
Mailing Address - Phone:205-567-3951
Mailing Address - Fax:
Practice Address - Street 1:510 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACK CREEK
Practice Address - State:NC
Practice Address - Zip Code:27813-9022
Practice Address - Country:US
Practice Address - Phone:252-281-1718
Practice Address - Fax:252-281-4842
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29079101YA0400X
NCP0192731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)