Healthcare Provider Details

I. General information

NPI: 1295379899
Provider Name (Legal Business Name): MALGORZATA STANCHAK MS, NCC, LCMHCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S GRIFFIN ST STE J
ELIZABETH CITY NC
27909-4693
US

IV. Provider business mailing address

733 OCEAN HWY S
HERTFORD NC
27944-1437
US

V. Phone/Fax

Practice location:
  • Phone: 252-573-1189
  • Fax:
Mailing address:
  • Phone: 252-573-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24145
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS13921
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: