Provider Demographics
NPI:1376258756
Name:KARLA STALLWORTH LLC
Entity Type:Organization
Organization Name:KARLA STALLWORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-821-6567
Mailing Address - Street 1:60 MAN MAR DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2270
Mailing Address - Country:US
Mailing Address - Phone:508-821-6567
Mailing Address - Fax:508-316-0924
Practice Address - Street 1:60 MAN MAR DR UNIT 5
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2270
Practice Address - Country:US
Practice Address - Phone:508-821-6567
Practice Address - Fax:508-316-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty