Provider Demographics
NPI:1538601448
Name:PAQUIN, STEFANIE MICHELLE (LLP, CAADC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MICHELLE
Last Name:PAQUIN
Suffix:
Gender:F
Credentials:LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20105 ALGER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1703
Mailing Address - Country:US
Mailing Address - Phone:586-899-1742
Mailing Address - Fax:
Practice Address - Street 1:595 FOREST AVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1775
Practice Address - Country:US
Practice Address - Phone:586-899-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016814103TC0700X
MI6361003391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical