Healthcare Provider Details

I. General information

NPI: 1457969198
Provider Name (Legal Business Name): STEFANIE ALSTON LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LEDYARD ST
DETROIT MI
48201
US

IV. Provider business mailing address

445 LEDYARD ST
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-962-9446
  • Fax: 313-962-6395
Mailing address:
  • Phone: 313-962-9446
  • Fax: 313-962-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number6401014768
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: