Provider Demographics
NPI:1396242467
Name:STALLINGS, TERRIE ELAINE (BS, CAC II)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:ELAINE
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:BS, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 MIDPOINT DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4324
Mailing Address - Country:US
Mailing Address - Phone:970-372-3144
Mailing Address - Fax:
Practice Address - Street 1:2114 MIDPOINT DR UNIT 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4324
Practice Address - Country:US
Practice Address - Phone:970-372-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)