Provider Demographics
NPI:1376017137
Name:STACY K DOCTOROFF LLPC, LLC
Entity Type:Organization
Organization Name:STACY K DOCTOROFF LLPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOCTOROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-259-5642
Mailing Address - Street 1:26413 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1263
Mailing Address - Country:US
Mailing Address - Phone:248-259-5642
Mailing Address - Fax:
Practice Address - Street 1:29260 FRANKLIN RD STE 111
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1196
Practice Address - Country:US
Practice Address - Phone:248-259-5642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health