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General NPI Number Information
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NPI Number | 1821458225
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Entity Type | Individual
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Provider Name | MANDY LEIGH STACKS LPC, ADC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 320 MIDLAND PKWY STE C
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City | SUMMERVILLE
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State | SC
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Zip | 29485-7195
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Country | US
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Telephone | 803-577-0265
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Fax |
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Provider Business Mailing Address
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Address Line | 146 SAINT CATHERINES CT
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City | SUMMERVILLE
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State | SC
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Zip | 29483-9055
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Country | US
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Telephone | 803-577-0265
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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 |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9989
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License Number State | SC
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