Provider Demographics
NPI:1689704363
Name:STACHIW, BEATRICE (LMSW CHT)
Entity Type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:
Last Name:STACHIW
Suffix:
Gender:F
Credentials:LMSW CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 RIVERSIDE DR
Mailing Address - Street 2:#9
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2717
Mailing Address - Country:US
Mailing Address - Phone:248-377-6783
Mailing Address - Fax:
Practice Address - Street 1:1134 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3042
Practice Address - Country:US
Practice Address - Phone:810-667-4111
Practice Address - Fax:810-667-4111
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010718821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical