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General NPI Number Information
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NPI Number | 1558766584
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Entity Type | Individual
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Provider Name | STACEY HOSTETTER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 311 MCBEE ST
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City | LINCOLNTON
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State | NC
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Zip | 28092-2818
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Country | US
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Telephone | 704-748-6113
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Fax | 704-735-1924
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Provider Business Mailing Address
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Address Line | 350 PEE DEE AVE STE 101
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City | ALBEMARLE
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State | NC
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Zip | 28001-4945
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Country | US
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Telephone | 704-986-1500
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Fax | 866-404-5622
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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 | C011433
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License Number State | NC
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