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Organization
J. THOMAS STACK, PH.D., PA
Active
Organization
J. THOMAS STACK, PH.D., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J THOMAS STACK PH.D. (PRESIDENT)
(910) 347-5511
Entity
Organization
Contact information
Practice address
2444 COMMERCE RD, JACKSONVILLE, NC 28546-7560
(910) 347-5511
(910) 346-3970
Mailing address
2444 COMMERCE RD, JACKSONVILLE, NC 28546-7560
(910) 347-5511
(910) 346-3970
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0321
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0320667
BLUE CROSS
NC
05
—
6000016
—
NC
01
—
8D26D8F5BE
TRICARE
—
Enumeration date
08/24/2006
Last updated
08/22/2020
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