Provider Demographics
NPI:1417403551
Name:GASTON, STANASIA LENISE (MS, NCC,LCMHC)
Entity Type:Individual
Prefix:MISS
First Name:STANASIA
Middle Name:LENISE
Last Name:GASTON
Suffix:
Gender:F
Credentials:MS, NCC,LCMHC
Other - Prefix:MRS
Other - First Name:STANASIA
Other - Middle Name:LENISE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, NCC,LCMHC
Mailing Address - Street 1:5334 CASPER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2375
Mailing Address - Country:US
Mailing Address - Phone:708-296-7664
Mailing Address - Fax:
Practice Address - Street 1:5334 CASPER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2375
Practice Address - Country:US
Practice Address - Phone:708-296-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15802101YM0800X
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)