Basic Information
| Provider Information | |||||||||
| NPI: | 1225306798 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANIFER | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 N MACOMB ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481622904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342401760 | ||||||||
| FaxNumber: | 7342401763 | ||||||||
| Practice Location | |||||||||
| Address1: | 14930 LAPLAISANCE RD #123 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342403850 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401012047 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.