Provider Demographics
NPI:1992319685
Name:SMALL, STUART EDWARD (LCMHC, LCAS, CCS-I)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:EDWARD
Last Name:SMALL
Suffix:
Gender:M
Credentials:LCMHC, LCAS, CCS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9170
Mailing Address - Country:US
Mailing Address - Phone:910-234-4638
Mailing Address - Fax:
Practice Address - Street 1:3709 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1127
Practice Address - Country:US
Practice Address - Phone:252-206-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25688101YA0400X
NCA15781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health