Provider Demographics
NPI:1255767257
Name:STALLWORTH, LIA G (MSW)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:G
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:G
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1252
Mailing Address - Country:US
Mailing Address - Phone:317-963-1592
Mailing Address - Fax:317-962-9657
Practice Address - Street 1:1801 N SENATE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1252
Practice Address - Country:US
Practice Address - Phone:317-963-1592
Practice Address - Fax:317-962-9657
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005085A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical