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1316164924 NPI number — STACIA JACKSON MARCELLIN LCSW

NPI Number: 1316164924
Health Care Provider/Practitioner: STACIA JACKSON MARCELLIN LCSW

Information about “1316164924” NPI (STACIA JACKSON MARCELLIN LCSW) exists in 1316164924 in HTML format HTML  |  1316164924 in plain Text format TXT  |  1316164924 in PDF (Portable Document Format) PDF  |  1316164924 in an XML format XML  formats.

NPI Number : 1316164924 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316164924",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MARCELLIN",
    "FirstName": "STACIA",
    "MiddleName": "JACKSON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "STACIA",
    "OtherMiddleName": "LENNETTE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LGSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5145 AVENING CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28215-8075",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-405-7403",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5145 AVENING CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28215-8075",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-405-7403",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/18/2007",
    "LastUpdateDate": "11/30/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "G11976",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "P003952",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "C006185",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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