Provider Demographics
NPI:1023718400
Name:PINE-STANCZYK, CHERYL (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:PINE-STANCZYK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 BIRD DOG LN
Mailing Address - Street 2:
Mailing Address - City:SPRUCE
Mailing Address - State:MI
Mailing Address - Zip Code:48762-9316
Mailing Address - Country:US
Mailing Address - Phone:248-520-0786
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1434
Practice Address - Country:US
Practice Address - Phone:989-358-7621
Practice Address - Fax:989-354-5898
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103840104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801103840Medicaid