Provider Demographics
NPI:1174283170
Name:STAMPS, ALAND DEWON (CCAR)
Entity Type:Individual
Prefix:
First Name:ALAND
Middle Name:DEWON
Last Name:STAMPS
Suffix:
Gender:M
Credentials:CCAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 KIESEL RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2446
Mailing Address - Country:US
Mailing Address - Phone:989-391-4046
Mailing Address - Fax:989-391-4047
Practice Address - Street 1:3442 KIESEL RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2446
Practice Address - Country:US
Practice Address - Phone:989-391-4046
Practice Address - Fax:989-391-4047
Is Sole Proprietor?:No
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
1797OtherCCAR RECOVERY COACH ACADEMY TRAINER
179OtherCCAR