Provider Demographics
NPI:1568826105
Name:STINNETTE, BOBBY (LPC)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:STINNETTE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BRUSH ST APT 1807
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4355
Mailing Address - Country:US
Mailing Address - Phone:202-459-3476
Mailing Address - Fax:
Practice Address - Street 1:19111 W 10 MILE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2417
Practice Address - Country:US
Practice Address - Phone:248-721-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional