Healthcare Provider Details

I. General information

NPI: 1780498238
Provider Name (Legal Business Name): STACEY HUTCHINSON BSW, QMHP, QIDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42850 GARFIELD RD STE 103
CLINTON TOWNSHIP MI
48038-5026
US

IV. Provider business mailing address

525 OKEMOS ST
MASON MI
48854-1224
US

V. Phone/Fax

Practice location:
  • Phone: 586-477-2054
  • Fax:
Mailing address:
  • Phone: 517-833-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: