Provider Demographics
NPI:1548276421
Name:CHRISTY, STEPHANIE ANN (LMSW CAADC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16453 COUNTRY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2391
Mailing Address - Country:US
Mailing Address - Phone:248-974-6295
Mailing Address - Fax:
Practice Address - Street 1:16453 COUNTRY KNOLL DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2391
Practice Address - Country:US
Practice Address - Phone:248-974-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95181041C0700X
MI68010848661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid
MI1883825Medicaid