Healthcare Provider Details

I. General information

NPI: 1609641042
Provider Name (Legal Business Name): STELLAR CLINIC CT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W CONGRESS ST
DETROIT MI
48226-3289
US

IV. Provider business mailing address

440 N BARRANCA AVE # 4885
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 734-584-0133
  • Fax: 844-333-0460
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE WANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-313-8413