Individual
TARA K. STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW-C
Contact information
Practice address
16701 MELFORD BLVD STE 400, BOWIE, MD 20715-4411
(415) 424-4266
(415) 520-6633
Mailing address
8300 ESTERS BLVD STE 900, IRVING, TX 75063-2233
(415) 424-4266
(415) 520-6633
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
19551
MD
1041C0700X
Clinical Social Worker
149.028059
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228022100
—
MD
Enumeration date
12/04/2014
Last updated
12/12/2024
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