Provider Demographics
NPI:1144710773
Name:JONES, STACY NICOLE (MSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:SHARON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1100 TORREY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3327
Mailing Address - Country:US
Mailing Address - Phone:810-494-7180
Mailing Address - Fax:810-215-1334
Practice Address - Street 1:1701 LAKE LANSING RD STE 120
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3798
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:810-215-1334
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68011028521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)