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General NPI Number Information
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NPI Number | 1609237619
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Entity Type | Organization
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Legal Business Name | LELA STOVALL, LLC
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD SUITE 112
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-802-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 16000 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-802-8003
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. LELA ANN STOVALL
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Credential | LPC
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Telephone | 313-743-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | MI
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