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General NPI Number Information
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NPI Number | 1093256976
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Entity Type | Individual
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Provider Name | STASA TODOROVIC LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 26650 EUREKA RD
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City | TAYLOR
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State | MI
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Zip | 48180-4835
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Country | US
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Telephone | 734-955-3550
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Fax | 734-955-3562
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Provider Business Mailing Address
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Address Line | 1777 TIMBER CREEK RD APT 1528
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1194
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Country | US
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Telephone | 313-784-7510
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6801098581
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 108986
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License Number State | TX
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