| J. Thomas Stack, Ph.d., Pa | |
|
2444 Commerce Rd Jacksonville NC 28546-7560 | |
| (910) 347-5511 | |
| (910) 346-3970 |
| Full Name | J. Thomas Stack, Ph.d., Pa |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2444 Commerce Rd, Jacksonville, North Carolina |
| Authorized Official Name and Position | J Thomas Stack (PRESIDENT) |
| Authorized Official Contact | 9103475511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Thomas Stack, Ph.d., Pa 2444 Commerce Rd Jacksonville NC 28546-7560 Ph: (910) 347-5511 | J. Thomas Stack, Ph.d., Pa 2444 Commerce Rd Jacksonville NC 28546-7560 Ph: (910) 347-5511 |
| NPI Number | 1962519165 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962519165 | NPI | - | NPPES |
| 6000016 | Medicaid | NC | |
| 0320667 | Other | NC | BLUE CROSS |
| 8D26D8F5BE | Other | TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0321 (North Carolina) | Primary |
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