Ms Kimberly J Stafford, LPC | |
243 Lakewood St, Detroit, MI 48215-3151 | |
(313) 420-9537 | |
Not Available |
Full Name | Ms Kimberly J Stafford |
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Gender | Female |
Speciality | Counselor - Professional |
Location | 243 Lakewood St, Detroit, Michigan |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1306011283 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 6401010739 (Michigan) | Primary |
Entity Name | Covenant Community Care, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1720134943 PECOS PAC ID: 1254393549 Enrollment ID: O20041029000105 |
Mailing Address | Practice Location Address |
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Ms Kimberly J Stafford, LPC 28000 Dequindre Rd, Warren, MI 48092-2468 Ph: (586) 753-0400 | Ms Kimberly J Stafford, LPC 243 Lakewood St, Detroit, MI 48215-3151 Ph: (313) 420-9537 |
Anthony Jerome Allen, AAS., CAC II Counselor Medicare: Not Enrolled in Medicare Practice Location: 12010 Linwood St, Detroit, MI 48206 Phone: 313-867-1090 Fax: 313-867-0706 | |
Mr. Brian R Cogliati, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1852 W Grand Blvd, 1852 W. Grand Blvd, Detroit, MI 48208 Phone: 313-894-8444 Fax: 313-894-5542 | |
Mr. Gregory Charles Guice, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 1151 Taylor Ave., Detroit, MI 48202 Phone: 313-874-8715 | |
Ms. Carol Potter, MA, BCBA, LBA Counselor Medicare: Not Enrolled in Medicare Practice Location: 2200 Hunt St, Detroit, MI 48207 Phone: 248-537-2516 | |
Mrs. Lisa Polk-woolfolk, MS, LLPC, CAC-M Counselor Medicare: Not Enrolled in Medicare Practice Location: 3731 Rivard St, Detroit, MI 48207 Phone: 313-258-9713 | |
Alicia Monique Lurry, LPC Counselor Medicare: Medicare Enrolled Practice Location: 8171 Parkland, Detroit, MI 48239 Phone: 313-282-7567 | |
Mr. Darren Kilgore, Counselor Medicare: Not Enrolled in Medicare Practice Location: 269 Walker St, 538, Detroit, MI 48207 Phone: 313-610-0134 |