Provider Demographics
NPI:1205451044
Name:STALLINGS, STEPHANIE DEMETRIUS (LCSWA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEMETRIUS
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 OXFORD BLVD APT B6
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9279
Mailing Address - Country:US
Mailing Address - Phone:240-583-9724
Mailing Address - Fax:
Practice Address - Street 1:307 BEECH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2818
Practice Address - Country:US
Practice Address - Phone:919-731-2119
Practice Address - Fax:919-739-4989
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical