Provider Demographics
NPI:1720518244
Name:STUCKES, NATIELA
Entity Type:Individual
Prefix:
First Name:NATIELA
Middle Name:
Last Name:STUCKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 ALLEN A BROWN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1153
Mailing Address - Country:US
Mailing Address - Phone:980-355-3737
Mailing Address - Fax:
Practice Address - Street 1:11601 ALLEN A BROWN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1153
Practice Address - Country:US
Practice Address - Phone:980-355-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-12-08
Deactivation Date:2019-03-18
Deactivation Code:
Reactivation Date:2022-07-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC82-1781607OtherE.I.N