Provider Demographics
NPI:1790854297
Name:STANIFER, DAVID DEAN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MISS
First Name:DAVID
Middle Name:DEAN
Last Name:STANIFER
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Gender:M
Credentials:PSYCHOLOGIST
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Mailing Address - Street 1:700 STEWART RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5304
Mailing Address - Country:US
Mailing Address - Phone:734-240-1760
Mailing Address - Fax:734-240-1780
Practice Address - Street 1:700 STEWART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5304
Practice Address - Country:US
Practice Address - Phone:734-240-1760
Practice Address - Fax:734-240-1780
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
MI6301010797103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108955470OtherBCBS