Individual
MISS STACY MARIE CHINEVERE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
326 JOHNSON ST, JACKSON, MI 49203
(517) 962-2258
Mailing address
326 JOHNSON ST, JACKSON, MI 49203
(517) 962-2258
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
516777585266
MI
Other
Enumeration date
11/11/2009
Last updated
11/11/2009
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