Provider Demographics
NPI:1306408323
Name:STEMKOWSKI, MARY LAIRD (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LAIRD
Last Name:STEMKOWSKI
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 LANSING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-6029
Mailing Address - Country:US
Mailing Address - Phone:704-770-8966
Mailing Address - Fax:
Practice Address - Street 1:330 S YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4052
Practice Address - Country:US
Practice Address - Phone:704-864-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0132101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty