Provider Demographics
NPI:1154381564
Name:JAUDON, STACEY L (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:JAUDON
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:PO BOX 18616
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28814-0616
Mailing Address - Country:US
Mailing Address - Phone:828-230-2507
Mailing Address - Fax:
Practice Address - Street 1:1 ZILLICOA ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1038
Practice Address - Country:US
Practice Address - Phone:828-230-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003210Medicaid
NC480689OtherVALUE OPTIONS
NCC4776OtherMEDCOST
NC133WNOtherBCBSNC
NC2876409Medicare ID - Type UnspecifiedMEDICARE