Healthcare Provider Details

I. General information

NPI: 1811560402
Provider Name (Legal Business Name): HANNAH GRACE STARK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E GRAND RIVER AVE STE 205
BRIGHTON MI
48116-1510
US

IV. Provider business mailing address

61343 DEAN DR
SOUTH LYON MI
48178-1580
US

V. Phone/Fax

Practice location:
  • Phone: 810-962-0616
  • Fax:
Mailing address:
  • Phone: 810-620-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: