Healthcare Provider Details

I. General information

NPI: 1942312483
Provider Name (Legal Business Name): ANDREA MARIE STILES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14675 DOWNEY RD
MUSSEY MI
48014-3121
US

IV. Provider business mailing address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-3583
  • Fax:
Mailing address:
  • Phone: 810-966-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: