Provider Demographics
NPI:1124364427
Name:TIMMONS STASKIEWICZ, CARRI JOY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRI
Middle Name:JOY
Last Name:TIMMONS STASKIEWICZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S BURDICK ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-6219
Mailing Address - Country:US
Mailing Address - Phone:269-381-4446
Mailing Address - Fax:
Practice Address - Street 1:414 S BURDICK ST
Practice Address - Street 2:STE. 200
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-6219
Practice Address - Country:US
Practice Address - Phone:269-381-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010882531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical