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NPI Code Detail

MEDICARE: MANDY LEIGH STACKS LPC, ADC

MEDICARE: MANDY LEIGH STACKS LPC, ADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorSC
2101YP2500XProfessional Counselor9989SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821458225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY LEIGH STACKS LPC, ADC
Provider Business Mailing Address
First Line : 146 SAINT CATHERINES CT
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-9055
Country : US
Telephone Number : 803-577-0265
Fax Number :
Provider Business Practice Location Address
First Line : 320 MIDLAND PKWY STE C
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29485-7195
Country : US
Telephone Number : 803-577-0265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2016
Last Update Date : 12/13/2024

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