Individual
STACEY SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
4523 PARK RD # A102, CHARLOTTE, NC 28209-3700
(704) 919-0411
Mailing address
3131 FOUNDRY DR APT 4119, CHARLOTTE, NC 28217-3813
(617) 412-1554
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21718
NC
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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