Provider Demographics
NPI:1821330630
Name:THE STONE CENTER FOR COUNSELING & LEADERSHIP
Entity Type:Organization
Organization Name:THE STONE CENTER FOR COUNSELING & LEADERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, BCC
Authorized Official - Phone:704-665-0065
Mailing Address - Street 1:1821 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6112
Mailing Address - Country:US
Mailing Address - Phone:704-665-0065
Mailing Address - Fax:704-335-4001
Practice Address - Street 1:1821 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6112
Practice Address - Country:US
Practice Address - Phone:704-665-0065
Practice Address - Fax:704-335-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386GOtherBCBS