MEDICARE: CHANCEY STALNAKER

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
1	101YM0800X	Mental Health Counselor	A16278	NC

General Provider Information

NPI Number	:	1841872140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANCEY STALNAKER

Provider Business Mailing Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2200
Country	:	US
Telephone Number	:	704-864-1477
Fax Number	:	704-396-7524

Provider Business Practice Location Address
First Line	:	1528 UNION RD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2200
Country	:	US
Telephone Number	:	704-864-1477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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Directions to “ CHANCEY STALNAKER ” Practice Location

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