Provider Demographics
NPI:1477883726
Name:STUCKEY, DOMINICA NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DOMINICA
Middle Name:NICOLE
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1852
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-1852
Mailing Address - Country:US
Mailing Address - Phone:843-456-5183
Mailing Address - Fax:
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-3157
Practice Address - Country:US
Practice Address - Phone:843-456-5183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health