Active NPI
Stacia Jackson Marcellin, LCSW
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1316164924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C006185
- Practice address
- 5145 Avening CT
Charlotte, NC 28215-8075 - Phone
- (704) 405-7403
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | G11976 | MD | |
| Clinical Social Worker | 1041C0700X | P003952 | NC | |
| Clinical Social Worker | 1041C0700X | C006185 | NC | Primary |
Addresses
Primary practice location
5145 Avening CT
Charlotte, NC 28215-8075
Mailing address
5145 Avening CT
Charlotte, NC 28215-8075
Phone (704) 405-7403
Other names 1
- Stacia Lennette Jackson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G11976 | MD | MD | Clinical Social Worker |
| C006185 | NC | MD | Clinical Social Worker |
| P003952 | NC | MD | Clinical Social Worker |
Interoperability endpoints
- stacia.marcellin.1@30520.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512000000000",
"number": "1316164924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5145 AVENING CT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282158075",
"telephone_number": "704-405-7403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5145 AVENING CT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282158075",
"telephone_number": "704-405-7403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCELLIN",
"first_name": "STACIA",
"middle_name": "JACKSON",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2017-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "G11976",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P003952",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C006185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STACIA",
"last_name": "JACKSON",
"middle_name": "LENNETTE",
"credential": "LGSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charlotte, NC
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- Marcela Mujica DMD III PLLC (All Kids Pediatric Dentistry)
- Marcela Mujica, DMD, a, PLLC
- Avianna Jhane Marcelin
- Alyssa Marchand, MA, LCMHC
- Jennifer Marchesani Keyvan, PSYD
- Ashley Marchi, DPT
- Heidi C Marciano, D.O.
- Marcie L. Koontz O.D. PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.