Provider Demographics
NPI:1487319802
Name:STANTON, KALI MARIE (LLMSW)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:MARIE
Last Name:STANTON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 CATALPA
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7035
Mailing Address - Country:US
Mailing Address - Phone:517-206-8209
Mailing Address - Fax:
Practice Address - Street 1:3819 CATALPA
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-7035
Practice Address - Country:US
Practice Address - Phone:517-206-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851111180101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor