Healthcare Provider Details

I. General information

NPI: 1497048425
Provider Name (Legal Business Name): RESOURCES FOR DEVELOPMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S CENTER ST
ROYAL OAK MI
48067-3230
US

IV. Provider business mailing address

905 S CENTER ST
ROYAL OAK MI
48067-3230
US

V. Phone/Fax

Practice location:
  • Phone: 248-546-3304
  • Fax: 248-546-3305
Mailing address:
  • Phone: 248-546-3304
  • Fax: 248-546-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005353
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARGARET STACK
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 248-546-3304