Provider Demographics
NPI:1700022993
Name:WOLAN-STACHURA, IZABELA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:IZABELA
Middle Name:
Last Name:WOLAN-STACHURA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 EATON GATE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3884
Mailing Address - Country:US
Mailing Address - Phone:586-822-8551
Mailing Address - Fax:
Practice Address - Street 1:3816 EATON GATE LN
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3884
Practice Address - Country:US
Practice Address - Phone:586-822-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional