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General NPI Number Information
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NPI Number | 1538787411
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Entity Type | Individual
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Provider Name | CARRIE STUCK LCDCIII
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 107 S MAIN ST STE B
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City | CLYDE
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State | OH
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Zip | 43410-1667
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Country | US
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Telephone | 419-688-7812
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Fax |
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Provider Business Mailing Address
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Address Line | 12123 TOWNSHIP ROAD 178
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City | BELLEVUE
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State | OH
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Zip | 44811-9555
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCIII.111018
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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