Provider Demographics
NPI:1992036115
Name:ALUMBAUGH, STACI L (LCSW)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:L
Last Name:ALUMBAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:SWIFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8294
Mailing Address - Fax:843-663-8166
Practice Address - Street 1:4220 CAROLINA EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4220
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:843-663-8166
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC168801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN292440001OtherMEDICARE