Healthcare Provider Details

I. General information

NPI: 1831023787
Provider Name (Legal Business Name): STEPHANIE JOYCE MARTIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 SASHABAW RD STE B
CLARKSTON MI
48346-2269
US

IV. Provider business mailing address

5461 WOODCREEK DR
CLARKSTON MI
48348-4850
US

V. Phone/Fax

Practice location:
  • Phone: 248-636-5872
  • Fax:
Mailing address:
  • Phone: 248-636-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: