Healthcare Provider Details

I. General information

NPI: 1679860340
Provider Name (Legal Business Name): MICHELLE STANLEY MSW, LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 S 17TH ST SUITE 1
WILMINGTON NC
28401-6600
US

IV. Provider business mailing address

1110 RODERICK AVE
WILMINGTON NC
28401-5602
US

V. Phone/Fax

Practice location:
  • Phone: 910-632-2191
  • Fax: 910-632-2354
Mailing address:
  • Phone: 919-749-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008148
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: