Provider Demographics
NPI:1386043925
Name:STACER, ELIZABETH J (BHS, SST, DP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:STACER
Suffix:
Gender:F
Credentials:BHS, SST, DP-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:POMERICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SST, DP-C
Mailing Address - Street 1:3400 S WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4958
Mailing Address - Country:US
Mailing Address - Phone:989-755-1072
Mailing Address - Fax:989-755-1401
Practice Address - Street 1:3400 S WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4958
Practice Address - Country:US
Practice Address - Phone:989-755-1072
Practice Address - Fax:989-755-1401
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)