Healthcare Provider Details

I. General information

NPI: 1245738822
Provider Name (Legal Business Name): STACEY ALISE JOINER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD
DETROIT MI
48236-2167
US

IV. Provider business mailing address

15073 INKSTER RD
LIVONIA MI
48154-3939
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7230
  • Fax: 313-343-7449
Mailing address:
  • Phone: 313-510-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: