Provider Demographics
NPI:1699106906
Name:STOUPAS, GEORGE (PHD, LCMHC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:STOUPAS
Suffix:
Gender:M
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 FINSBURY RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1715
Mailing Address - Country:US
Mailing Address - Phone:561-779-9598
Mailing Address - Fax:
Practice Address - Street 1:2594 REYNOLDA RD STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4601
Practice Address - Country:US
Practice Address - Phone:561-779-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3904106H00000X
FL12159101YM0800X
NC16866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist