Individual
JENNA STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC-A, LCAS-A
Contact information
Practice address
2806 REYNOLDA RD STE 257, WINSTON SALEM, NC 27106-3102
(336) 223-6700
Mailing address
2806 REYNOLDA RD STE 257, WINSTON SALEM, NC 27106-3102
(336) 223-6700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-24745
NC
101YP2500X
Professional Counselor
Primary
A14431
NC
Other
Enumeration date
10/22/2018
Last updated
02/18/2022
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