Provider Demographics
NPI:1861571846
Name:STONEBROOK COUNSELING ASSOCIATES PLLC
Entity type:Organization
Organization Name:STONEBROOK COUNSELING ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DAHMS
Authorized Official - Last Name:PETRIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-343-4695
Mailing Address - Street 1:37799 PROFESSIONAL CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48754
Mailing Address - Country:US
Mailing Address - Phone:248-343-4695
Mailing Address - Fax:
Practice Address - Street 1:37799 PROFESSIONAL CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48754
Practice Address - Country:US
Practice Address - Phone:248-343-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801033601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N96600Medicare ID - Type Unspecified