Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MI | |
Y | 101YS0200X | School Counselor | MI |
NPI | 1124797352 |
---|---|
Provider Name | Stephanie Azar |
First Address | Novi, MI 48375-0203 |
Second Address | Novi, MI 48375-0203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2021 |
Last Update Date | 10/09/2021 |