Provider Demographics
NPI:1902450901
Name:WITTIG, STEPHANIE CHAUNTELE (LPC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:CHAUNTELE
Last Name:WITTIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3434
Mailing Address - Country:US
Mailing Address - Phone:231-346-5228
Mailing Address - Fax:231-929-0416
Practice Address - Street 1:116 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2524
Practice Address - Country:US
Practice Address - Phone:231-346-5228
Practice Address - Fax:231-929-0416
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222833101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)