Healthcare Provider Details

I. General information

NPI: 1922605021
Provider Name (Legal Business Name): STACIA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 BILTMORE AVE STE 200
ASHEVILLE NC
28801-4558
US

IV. Provider business mailing address

1819 PEACHTREE RD NE STE 450
ATLANTA GA
30309-1853
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013063
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC013063
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: