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General NPI Number Information
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NPI Number | 1467736728
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Entity Type | Organization
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Legal Business Name | DAVID STACKHOUSE INC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 101 MAIN ST
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City | SPARTA
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State | NJ
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Zip | 07871-1930
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Country | US
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Telephone | 973-886-9701
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Fax | 973-729-4611
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Provider Business Mailing Address
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Address Line | PO BOX 481
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City | SPARTA
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State | NJ
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Zip | 07871-0481
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Country | US
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Telephone | 973-886-9701
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Fax | 973-729-4611
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID RAY STACKHOUSE
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Credential |
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Telephone | 973-886-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00844700
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License Number State | NJ
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