Provider Demographics
NPI:1184866907
Name:WILSON, STEFFANY MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:STEFFANY
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:718 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162
Mailing Address - Country:US
Mailing Address - Phone:734-240-8400
Mailing Address - Fax:734-240-4450
Practice Address - Street 1:700 STEWART RD
Practice Address - Street 2:SUITE 105 THE FAMILY CENTER
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-240-1760
Practice Address - Fax:734-240-1787
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker