Provider Demographics
NPI:1346539285
Name:STOLTZ, ASA K (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ASA
Middle Name:K
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ASA
Other - Middle Name:K
Other - Last Name:BERGGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:226 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5404
Mailing Address - Country:US
Mailing Address - Phone:910-321-3703
Mailing Address - Fax:910-485-4752
Practice Address - Street 1:226 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5404
Practice Address - Country:US
Practice Address - Phone:910-321-3703
Practice Address - Fax:910-485-4752
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9011A106H00000X
FLMT2552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist