Provider Demographics
NPI:1417003856
Name:STOKES, KATRINA DAPHNE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:DAPHNE
Last Name:STOKES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10720 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1734
Mailing Address - Country:US
Mailing Address - Phone:313-882-0482
Mailing Address - Fax:
Practice Address - Street 1:18090 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6251
Practice Address - Country:US
Practice Address - Phone:313-574-7636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI546901Medicare UPIN
MI7631752Medicare UPIN