J. Thomas Stack, PH.D., PA

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

0321 Issued in NC

Legal business name

J. THOMAS STACK, PH.D., PA

Practice address

2444 Commerce Rd
Jacksonville, NC 28546-7560

Phone

(910) 347-5511

Fax

(910) 346-3970

NPI assigned

Aug 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. J Thomas Stack, PH.D.

Title

President

Phone

(910) 347-5511

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962519165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2444 COMMERCE RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467560",
            "telephone_number": "910-347-5511",
            "fax_number": "910-346-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 COMMERCE RD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467560",
            "telephone_number": "910-347-5511",
            "fax_number": "910-346-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. THOMAS STACK, PH.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-347-5511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NC",
            "license": "0321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0320667",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000016",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "8D26D8F5BE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.