Provider Demographics
NPI:1518920503
Name:OLDEN, STACEY LINNETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LINNETTE
Last Name:OLDEN
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 1:4822 ALBEMARLE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6668
Mailing Address - Country:US
Mailing Address - Phone:803-446-3905
Mailing Address - Fax:980-207-1005
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:803-446-3905
Practice Address - Fax:980-207-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4645101YP2500X
NC8534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional