Provider Demographics
NPI:1477672962
Name:STALLWORTH, CAROL GAIL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:GAIL
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 HELLING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8619
Mailing Address - Country:US
Mailing Address - Phone:530-265-7222
Mailing Address - Fax:
Practice Address - Street 1:995 HELLING WAY
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8619
Practice Address - Country:US
Practice Address - Phone:530-265-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health