Provider Demographics
NPI:1689188500
Name:STAINE, CHARISSE MONIQUE (MA,MED,LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:MONIQUE
Last Name:STAINE
Suffix:
Gender:F
Credentials:MA,MED,LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30050 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1575
Mailing Address - Country:US
Mailing Address - Phone:248-916-7869
Mailing Address - Fax:
Practice Address - Street 1:30050 FOREST DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1575
Practice Address - Country:US
Practice Address - Phone:248-916-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional