Provider Demographics
NPI:1558658799
Name:ESTES, STACIE R
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:R
Last Name:ESTES
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 1:2129 STATESVILLE BLVD.
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1411
Mailing Address - Country:US
Mailing Address - Phone:704-633-3616
Mailing Address - Fax:
Practice Address - Street 1:205 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28370-8712
Practice Address - Country:US
Practice Address - Phone:910-295-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor