Provider Demographics
NPI:1437523925
Name:STANTON, STACIE LEA (MS, LLPC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LEA
Last Name:STANTON
Suffix:
Gender:F
Credentials:MS, LLPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 OCONNOR DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9039
Mailing Address - Country:US
Mailing Address - Phone:989-560-4935
Mailing Address - Fax:
Practice Address - Street 1:407 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2649
Practice Address - Country:US
Practice Address - Phone:989-560-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013580101Y00000X
MI2-00962101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor