Healthcare Provider Details

I. General information

NPI: 1184866907
Provider Name (Legal Business Name): STEFFANY MARIE WILSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STEWART RD SUITE 105 THE FAMILY CENTER
MONROE MI
48162
US

IV. Provider business mailing address

718 N MACOMB ST
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1760
  • Fax: 734-240-1787
Mailing address:
  • Phone: 734-240-8400
  • Fax: 734-240-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801085434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: