Provider Demographics
NPI:1154435451
Name:NAVARRO, ANN STODART (MA, LPA, LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:STODART
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:MA, LPA, LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:STODART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3763 SUGAR SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4993
Mailing Address - Country:US
Mailing Address - Phone:704-868-4974
Mailing Address - Fax:704-867-2970
Practice Address - Street 1:115 N LAFAYETTE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4445
Practice Address - Country:US
Practice Address - Phone:704-418-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2944101YP2500X
NC1693103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107062Medicaid