Provider Demographics
NPI:1184142861
Name:STURGIS, PAUL WESLEY JR (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WESLEY
Last Name:STURGIS
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 5TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3400
Mailing Address - Country:US
Mailing Address - Phone:980-525-6410
Mailing Address - Fax:
Practice Address - Street 1:1801 E 5TH ST STE 213
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3400
Practice Address - Country:US
Practice Address - Phone:980-525-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker