Individual
STANLEY LARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8633 SOUTHFIELD FWY, DETROIT, MI 48228-1975
(313) 804-8635
Mailing address
14056 ASHTON RD, DETROIT, MI 48223-3532
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
MI
Other
Enumeration date
09/19/2025
Last updated
09/19/2025
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