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General NPI Number Information
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NPI Number | 1063593424
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Entity Type | Organization
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Legal Business Name | DAVID P. STANISLAW, JR., M.S.W., P.C.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 191 N OLD WOODWARD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3350
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Country | US
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Telephone | 248-645-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 191 N OLD WOODWARD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3350
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Country | US
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Telephone | 248-645-2777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID P. STANISLAW
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Credential | M.S.W.
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Telephone | 248-645-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801000270
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License Number State | MI
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