MEDICARE: MS. KATRINA DAPHNE STOKES MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401006840	MI
2	101YM0800X	Mental Health Counselor	6401006840	MI

General Provider Information

NPI Number	:	1417003856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATRINA DAPHNE STOKES MA, LPC

Provider Business Mailing Address
First Line	:	2925 RUSSELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4825
Country	:	US
Telephone Number	:	313-574-7636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 RUSSELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4825
Country	:	US
Telephone Number	:	313-574-7636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	09/24/2024

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