Provider Demographics
NPI:1801910682
Name:STANFIELD, MATTHEW DOUGLAS I (MA LSGC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:STANFIELD
Suffix:I
Gender:M
Credentials:MA LSGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2468
Mailing Address - Country:US
Mailing Address - Phone:734-457-4340
Mailing Address - Fax:
Practice Address - Street 1:25 S MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2468
Practice Address - Country:US
Practice Address - Phone:734-457-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009598101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)