Provider Demographics
NPI:1093971673
Name:STANGIS, CHERIE ANN (LLP, LPC)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:ANN
Last Name:STANGIS
Suffix:
Gender:F
Credentials:LLP, LPC
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:ANN
Other - Last Name:JOSEFOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP, LPC
Mailing Address - Street 1:2941 S GULLEY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3160
Mailing Address - Country:US
Mailing Address - Phone:313-278-3040
Mailing Address - Fax:
Practice Address - Street 1:2941 S GULLEY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3160
Practice Address - Country:US
Practice Address - Phone:313-278-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007364101Y00000X
MI6301011093103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629316815OtherLIFE SKILLS VILLAGE