Provider Demographics
NPI:1477523173
Name:STANLEY, KAROLYN STARK (LCSW, LPA)
Entity Type:Individual
Prefix:MS
First Name:KAROLYN
Middle Name:STARK
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LCSW, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4927
Mailing Address - Country:US
Mailing Address - Phone:252-341-5836
Mailing Address - Fax:
Practice Address - Street 1:504B DEXTER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6333
Practice Address - Country:US
Practice Address - Phone:252-353-1114
Practice Address - Fax:252-353-1119
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1700103TC0700X
NCCOO19771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79272OtherBLUE CROSS/BLUE SHIELD
NC6002714Medicaid
NC79272OtherBLUE CROSS/BLUE SHIELD