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General NPI Number Information
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NPI Number | 1477966950
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Entity Type | Organization
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Legal Business Name | MI CENTER FOR STRESS & COPING LLC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 13854 LAKESIDE CIR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-1316
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Country | US
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Telephone | 586-690-1568
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Fax |
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Provider Business Mailing Address
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Address Line | 18198 MILLAR RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-2088
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Country | US
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Telephone | 586-465-1482
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Fax |
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Authorized Official
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Title or Position | LEAD CLINICIAN
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Name | DARCIE A DIBASIO
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Credential | N.P.
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Telephone | 586-465-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4704249095
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License Number State | MI
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