Provider Demographics
NPI:1487812038
Name:STANLEY, DOUGLAS WAYNE (MSW, LMSW FAODP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MSW, LMSW FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2147
Mailing Address - Country:US
Mailing Address - Phone:248-698-2250
Mailing Address - Fax:
Practice Address - Street 1:43902 WOODWARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-338-1700
Practice Address - Fax:248-338-1732
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010903701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical