J. THOMAS STACK PH.D. PA NPI 1962519165

NPI Information

NPI: 1962519165
Provider Name: J. THOMAS STACK, PH.D., PA
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2444 COMMERCE RD
JACKSONVILLE, NC
ZIP 28546
Phone: (910) 347-5511
Get Directions

J. THOMAS STACK, PH.D., PA is a mental health (including community mental health center) clinic center in Jacksonville, NC. J. THOMAS STACK, PH.D., PA NPI is 1962519165. The provider is registered as an organization entity type.

The provider's business location address is:

2444 COMMERCE RD
JACKSONVILLE, NC
ZIP 28546-560
Phone: (910) 347-5511
Fax: (910) 346-3970

The provider's authorized official is J Thomas Stack .
The authorized official title is President and has the following contact phone number (910) 347-5511.

The enumeration date for this NPI number is 8/24/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	0321	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8D26D8F5BE	OTHER		TRICARE
2	6000016	MEDICAID	NORTH CAROLINA
3	0320667	OTHER	NORTH CAROLINA	BLUE CROSS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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