Provider Demographics
NPI:1588015200
Name:STONE, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:
Other - Last Name:PELLEGRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1316
Mailing Address - Country:US
Mailing Address - Phone:517-652-9700
Mailing Address - Fax:
Practice Address - Street 1:5093 E BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4772
Practice Address - Country:US
Practice Address - Phone:810-772-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011065241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical