Provider Demographics
NPI:1508406711
Name:NEWBERRY, STACIE ANN (BA)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:ANN
Last Name:NEWBERRY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1686
Mailing Address - Country:US
Mailing Address - Phone:586-983-2670
Mailing Address - Fax:586-983-2672
Practice Address - Street 1:6902 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1686
Practice Address - Country:US
Practice Address - Phone:586-983-2670
Practice Address - Fax:586-983-2672
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)