Healthcare Provider Details

I. General information

NPI: 1255598504
Provider Name (Legal Business Name): LAURA ANN STANJONES MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

IV. Provider business mailing address

11800 E 12 MILE RD
WARREN MI
48093-3472
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-5872
  • Fax: 586-573-5583
Mailing address:
  • Phone: 586-573-5872
  • Fax: 586-573-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: