Basic Information
| Provider Information | |||||||||
| NPI: | 1952400848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STERN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28000 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480922468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867530405 | ||||||||
| FaxNumber: | 5867530404 | ||||||||
| Practice Location | |||||||||
| Address1: | 20811 KELLY RD | ||||||||
| Address2: | |||||||||
| City: | EASTPOINTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480213139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864453612 | ||||||||
| FaxNumber: | 5864450700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301005261 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | 104100000X | 6801002112 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 4101005829 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.