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General NPI Number Information
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NPI Number | 1457943359
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Entity Type | Individual
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Provider Name | DYLAN STOCKS CADC-I, MSW, LCSWA
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Gender | Male
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 3460 CAPUANO RD
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City | LUMBERTON
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State | NC
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Zip | 28358-3478
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Country | US
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Telephone | 910-522-0421
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | LUMBERTON
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State | NC
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Zip | 28359-0008
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Country | US
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Telephone | 910-522-0421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P014451
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License Number State | NC
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