Provider Demographics
NPI:1013373760
Name:STOKES, MICHAEL (MS, MCAP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:STOKES
Suffix:
Gender:M
Credentials:MS, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 PENTAX AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2379
Mailing Address - Country:US
Mailing Address - Phone:321-543-3622
Mailing Address - Fax:
Practice Address - Street 1:7 N COCOA BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7749
Practice Address - Country:US
Practice Address - Phone:321-631-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010480-2015101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health