Provider Demographics
NPI:1326553637
Name:STALLINGS, CHARLES LOYD (LADACII, SAP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LOYD
Last Name:STALLINGS
Suffix:
Gender:M
Credentials:LADACII, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. TRI COUNTY BLVD.
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-1431
Mailing Address - Country:US
Mailing Address - Phone:865-730-6628
Mailing Address - Fax:
Practice Address - Street 1:600 W. TRI COUNTY BLVD.
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-1431
Practice Address - Country:US
Practice Address - Phone:865-730-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10089338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)