Provider Demographics
NPI:1952449449
Name:MANCINE, STEPHANIE ANN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:MANCINE
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 1:177 N BARLOW RD
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48740-9607
Mailing Address - Country:US
Mailing Address - Phone:989-736-8157
Mailing Address - Fax:989-358-3762
Practice Address - Street 1:11745 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:OSSINEKE
Practice Address - State:MI
Practice Address - Zip Code:49766-9582
Practice Address - Country:US
Practice Address - Phone:989-471-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007747101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3502573OtherTAX ID NUMBER