=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346539285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASA K STOLTZ LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2011
-----------------------------------------------------
Last Update Date | 02/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 BRADFORD AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-321-3703
-----------------------------------------------------
Fax | 910-485-4752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 BRADFORD AVE
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28301-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-321-3703
-----------------------------------------------------
Fax | 910-485-4752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 9011A
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2552
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------