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General NPI Number Information
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NPI Number | 1790110781
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Entity Type | Individual
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Provider Name | STACY CHARLENE CARLTON LPN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3795 EAST NORTH SUITE 14
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City | GREENVILLE
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State | SC
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Zip | 29617-3304
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Country | US
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Telephone | 864-434-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 204 CRANE AVE
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City | GREENVILLE
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State | SC
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Zip | 29617-3304
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Country | US
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Telephone | 864-434-6141
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7700
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 53144
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License Number State | SC
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