Individual
MRS. MARY LUCILLE STODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
745 ALFA CT APT 1A, PORTAGE, MI 49002-2979
(989) 305-2095
Mailing address
745 ALFA CT APT 1A, PORTAGE, MI 49002-2979
(989) 305-2095
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6401008403
MI
Other
Enumeration date
03/28/2012
Last updated
03/28/2012
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