Provider Demographics
NPI:1598877714
Name:STACHOWIAK, KEVIN B (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:B
Last Name:STACHOWIAK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10751 S SAGINAW ST STE L
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8169
Mailing Address - Country:US
Mailing Address - Phone:810-691-3916
Mailing Address - Fax:
Practice Address - Street 1:10751 S SAGINAW ST STE L
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8169
Practice Address - Country:US
Practice Address - Phone:866-227-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010950651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical