Provider Demographics
NPI:1447429261
Name:STACK, MARGARET ANN (PHD, APBB)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:STACK
Suffix:
Gender:F
Credentials:PHD, APBB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26789 WOODWARD AVE
Mailing Address - Street 2:SUITE #107C
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1335
Mailing Address - Country:US
Mailing Address - Phone:248-546-3304
Mailing Address - Fax:248-546-3305
Practice Address - Street 1:777 LIVERNOIS ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2306
Practice Address - Country:US
Practice Address - Phone:248-546-3304
Practice Address - Fax:248-546-3305
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical