Provider Demographics
NPI:1053789891
Name:STANFIELD, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20916 MACK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1387
Mailing Address - Country:US
Mailing Address - Phone:248-979-4328
Mailing Address - Fax:
Practice Address - Street 1:20916 MACK AVE STE 100
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1387
Practice Address - Country:US
Practice Address - Phone:248-979-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013316101YA0400X
MI63610038711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI35-2482009OtherINTERNAL REVENUE SERVICE