Provider Demographics
NPI:1699126490
Name:CRAVEN-GATLING, STACEY (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:CRAVEN-GATLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRINYAN CT
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8828
Mailing Address - Country:US
Mailing Address - Phone:910-638-3228
Mailing Address - Fax:
Practice Address - Street 1:325 PAGE RD N
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-4637
Practice Address - Country:US
Practice Address - Phone:910-638-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0093631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical