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General NPI Number Information
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NPI Number | 1952400848
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Entity Type | Individual
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Provider Name | CHARLES R STERN PHD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 20811 KELLY RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-3139
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Country | US
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Telephone | 586-445-3612
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Fax | 586-445-0700
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Provider Business Mailing Address
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Address Line | 28000 DEQUINDRE RD
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City | WARREN
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State | MI
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Zip | 48092-2468
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Country | US
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Telephone | 586-753-0405
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Fax | 586-753-0404
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005261
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801002112
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101005829
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License Number State | MI
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