Provider Demographics
NPI:1477966950
Name:MI CENTER FOR STRESS & COPING LLC
Entity Type:Organization
Organization Name:MI CENTER FOR STRESS & COPING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIBASIO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:586-465-1482
Mailing Address - Street 1:18198 MILLAR RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2088
Mailing Address - Country:US
Mailing Address - Phone:586-465-1482
Mailing Address - Fax:
Practice Address - Street 1:13854 LAKESIDE CIR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1316
Practice Address - Country:US
Practice Address - Phone:586-690-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249095261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health