Provider Demographics
NPI:1770637142
Name:ANDERSON, STACEY CHATMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:CHATMAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 CHALLENGER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4081
Mailing Address - Country:US
Mailing Address - Phone:704-596-1156
Mailing Address - Fax:
Practice Address - Street 1:2020 E 7TH STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:704-376-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical