Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YM0800X | Mental Health Counselor | 200200610 | NC |
N | 101YP2500X | Professional Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TP0016X | Prescribing (Medical) | 200200610 | NC |
N | 207Q00000X | Family Doctor | 200200610 | NC |
NPI | 1508895285 |
---|---|
Provider Name | Sheila Clark Stallings |
First Address | Whitsett, NC 27377 |
Second Address | Greensboro, NC 27401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080188607 | RR MEDICARE (01) | NC |
1212660021 | DME (01) | NC |
8913117 | (05) | NC |
H32617 | (02) |