Provider Demographics
NPI:1477762987
Name:STACK, ANNE CARTER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:CARTER
Last Name:STACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 BEATTIES FORD RD
Mailing Address - Street 2:OUTREACH NORTH
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3711
Mailing Address - Country:US
Mailing Address - Phone:704-336-6550
Mailing Address - Fax:704-336-4553
Practice Address - Street 1:2845 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3711
Practice Address - Country:US
Practice Address - Phone:704-336-6550
Practice Address - Fax:704-336-4553
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0050791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical