Provider Demographics
NPI:1982862702
Name:STEPHENSON, CONSTANCE L (LMSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:L
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26862 WOODWARD AVE
Mailing Address - Street 2:102
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0957
Mailing Address - Country:US
Mailing Address - Phone:248-398-0740
Mailing Address - Fax:248-398-9456
Practice Address - Street 1:26862 WOODWARD AVE
Practice Address - Street 2:102
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0958
Practice Address - Country:US
Practice Address - Phone:248-398-0740
Practice Address - Fax:248-398-9456
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801002637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker