Provider Demographics
NPI:1821310707
Name:DICKINSON, STACY LYNN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:563 ALLEN RD
Mailing Address - Street 2:LOT #1
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1516
Mailing Address - Country:US
Mailing Address - Phone:734-323-1598
Mailing Address - Fax:734-451-5410
Practice Address - Street 1:8142 HONEYTREE BLVD
Practice Address - Street 2:BLDG. 61
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4109
Practice Address - Country:US
Practice Address - Phone:734-414-1795
Practice Address - Fax:734-451-5410
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility