Provider Demographics
NPI:1801343314
Name:MASON, STEPHANIE MARIE (LAC, DOM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 NW BROAD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4102
Mailing Address - Country:US
Mailing Address - Phone:910-725-0727
Mailing Address - Fax:910-725-0728
Practice Address - Street 1:780 NW BROAD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4102
Practice Address - Country:US
Practice Address - Phone:910-725-0727
Practice Address - Fax:910-725-0728
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist