Basic Information
| Provider Information | |||||||||
| NPI: | 1639210503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOECKEL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 STAYMON RD | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287869204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284568651 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 262 LEROY GEORGE DR | ||||||||
| Address2: | |||||||||
| City: | CLYDE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287217430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284528651 | ||||||||
| FaxNumber: | 8284528691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW001814 | GA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C005774 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 763038492A | 05 | NC | MEDICAID |