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General NPI Number Information
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NPI Number | 1598956369
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Entity Type | Individual
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Provider Name | STACEY MARIE DETTLOFF-JONES MA LPC LLP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 1410 E 14 MILE RD SUITE 900
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-1541
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Country | US
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Telephone | 248-524-8801
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Fax |
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Provider Business Mailing Address
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Address Line | 11594 DIAMOND DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-2621
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Country | US
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Telephone | 586-215-0805
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401008747
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013080
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802072238
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License Number State | MI
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