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General NPI Number Information
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NPI Number | 1053929927
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Entity Type | Individual
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Provider Name | STEPHANIE SHIRLEY BABCOCK LMSW, IMH-E
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Gender | Female
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 31205 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-1848
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Country | US
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Telephone | 586-213-1850
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Fax | 586-846-4354
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Provider Business Mailing Address
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Address Line | 6430 LOZON RD
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City | COTTRELLVILLE
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State | MI
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Zip | 48039-3109
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Country | US
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Telephone | 586-859-8349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801097106
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License Number State | MI
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