Provider Demographics
NPI:1376233239
Name:HIGNIGHT, STEPHANEA (LLC)
Entity Type:Individual
Prefix:
First Name:STEPHANEA
Middle Name:
Last Name:HIGNIGHT
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10247 E AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-2600
Mailing Address - Country:US
Mailing Address - Phone:806-584-2504
Mailing Address - Fax:
Practice Address - Street 1:10247 E AVONDALE CIR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-2600
Practice Address - Country:US
Practice Address - Phone:806-584-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health