Healthcare Provider Details

I. General information

NPI: 1497621650
Provider Name (Legal Business Name): NASHAUNA JACKSON STALLINGS MSW, LCSWA, LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
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

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

V. Phone/Fax

Practice location:
  • Phone: 252-331-0322
  • Fax: 252-331-0320
Mailing address:
  • Phone: 252-331-0322
  • Fax: 252-331-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-25616
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: