Provider Demographics
NPI:1396022356
Name:STIXX
Entity Type:Organization
Organization Name:STIXX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-292-1267
Mailing Address - Street 1:3302 SHERBORNE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8380
Mailing Address - Country:US
Mailing Address - Phone:803-412-5379
Mailing Address - Fax:
Practice Address - Street 1:602 MORGANTON BLVD SW
Practice Address - Street 2:SUITE B
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5823
Practice Address - Country:US
Practice Address - Phone:828-292-1267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health