Provider Demographics
NPI:1114406097
Name:CHOI, STEPHANIE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:678 FRONT AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:678 FRONT AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5323
Practice Address - Country:US
Practice Address - Phone:616-916-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88420101YP2500X
TN6600101YP2500X
MI6401018624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional