Individual
STACEY HARGIS SURRATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC, LCAS, CSI
Contact information
Practice address
10348 PARK RD, CHARLOTTE, NC 28210-8507
(704) 288-1097
(704) 817-7421
Mailing address
10348 PARK RD, CHARLOTTE, NC 28210-8507
(704) 288-1097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23622
NC
225A00000X
Music Therapist
10170
NC
Other
Enumeration date
04/09/2012
Last updated
06/29/2020
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