Healthcare Provider Details

I. General information

NPI: 1962336867
Provider Name (Legal Business Name): BETHANY FALLS STALLINGS LCMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

317 S CHESTER ST
GASTONIA NC
28052-3803
US

IV. Provider business mailing address

2324 LAKE VISTA DR
MT HOLLY NC
28120-9333
US

V. Phone/Fax

Practice location:
  • Phone: 980-522-8671
  • Fax: 980-276-2770
Mailing address:
  • Phone: 704-214-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: