Provider Demographics
NPI:1831564079
Name:STUCKEY, ROBERT LEWIS (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GARNER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4687
Mailing Address - Country:US
Mailing Address - Phone:919-832-7351
Mailing Address - Fax:919-882-9135
Practice Address - Street 1:2101 GARNER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4687
Practice Address - Country:US
Practice Address - Phone:919-832-7351
Practice Address - Fax:919-882-9135
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25422101YA0400X
NCC0111761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)