Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCAS-26381 | NC |
Y | 101YM0800X | Mental Health Counselor | A15829 | NC |
NPI | 1003433202 |
---|---|
Provider Name | Cecilia Stonebraker |
First Address | Mebane, NC 27302-9815 |
Second Address | Mebane, NC 27302-9815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2020 |
Last Update Date | 03/07/2020 |