Individual
MANDY LEIGH STACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, ADC
Contact information
Practice address
320 MIDLAND PKWY STE C, SUMMERVILLE, SC 29485-7195
(803) 577-0265
Mailing address
146 SAINT CATHERINES CT, SUMMERVILLE, SC 29483-9055
(803) 577-0265
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
SC
101YP2500X
Professional Counselor
Primary
9989
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AD08LA
—
SC
Enumeration date
02/26/2016
Last updated
12/13/2024
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