| Stellar Clinic Ct Pllc | |
|
220 W Congress St Detroit MI 48226-3289 | |
| (734) 584-0133 | |
| (844) 333-0460 |
| Full Name | Stellar Clinic Ct Pllc |
|---|---|
| Speciality | Counselor |
| Location | 220 W Congress St, Detroit, Michigan |
| Authorized Official Name and Position | George Wang (ADMINISTRATOR) |
| Authorized Official Contact | 2483138413 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stellar Clinic Ct Pllc 440 N Barranca Ave # 4885 Covina CA 91723-1722 Ph: () - | Stellar Clinic Ct Pllc 220 W Congress St Detroit MI 48226-3289 Ph: (734) 584-0133 |
| NPI Number | 1609641042 |
|---|---|
| Provider Enumeration Date | 11/15/2023 |
| Last Update Date | 07/31/2024 |
| Certification Date | 07/31/2024 |
| Medicare PECOS PAC ID | 0840633368 |
|---|---|
| Medicare Enrollment ID | O20240212001858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609641042 | NPI | - | NPPES |
| Provider Name | Rachel Hunter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427603182 PECOS PAC ID: 2062844491 Enrollment ID: I20191122001767 |
| Provider Name | Amanda L Thenor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609223783 PECOS PAC ID: 8224425426 Enrollment ID: I20220418000996 |
| Provider Name | Yasmeen Atyia Ayesha Burnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205543410 PECOS PAC ID: 4082085089 Enrollment ID: I20230131001602 |
| Provider Name | Marisusan Fryant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164165502 PECOS PAC ID: 7719369032 Enrollment ID: I20230726000797 |
| Provider Name | Evelyn Tommie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487602892 PECOS PAC ID: 2365885720 Enrollment ID: I20240213002335 |
| Provider Name | Brenna J Cash |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033554779 PECOS PAC ID: 6002267549 Enrollment ID: I20240213004668 |
| Provider Name | Matthew Fuller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750946950 PECOS PAC ID: 4183061922 Enrollment ID: I20240328001103 |
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