Provider Demographics
NPI:1821327230
Name:PIPPIN, MARY ELIZABETH STALLINGS (MS, LPA, BCBA)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:STALLINGS
Last Name:PIPPIN
Suffix:
Gender:F
Credentials:MS, LPA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 S WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3621
Mailing Address - Country:US
Mailing Address - Phone:919-971-3092
Mailing Address - Fax:
Practice Address - Street 1:1213 S WALNUT DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3621
Practice Address - Country:US
Practice Address - Phone:919-971-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NC2505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107707Medicaid