Provider Demographics
NPI:1346703493
Name:COMER, STACI (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5182 ALMOND DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7615
Mailing Address - Country:US
Mailing Address - Phone:980-621-0026
Mailing Address - Fax:
Practice Address - Street 1:801 E. MOREHEAD STREET
Practice Address - Street 2:SUITE 105 #1224
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:980-621-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0100501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical