Basic Information
| Provider Information | |||||||||
| NPI: | 1316543952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHALUPKA | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251420 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722251420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4224 SHUFFIELD DR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015268200 | ||||||||
| FaxNumber: | 5015265296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 7624-M | AR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | 7624-M | AR | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 7624-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.