Provider Demographics
NPI:1124797352
Name:AZAR, STEPHANIE (MA, LLPC, SCL)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:AZAR
Suffix:
Gender:F
Credentials:MA, LLPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23965 NOVI RD STE 160
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-0203
Mailing Address - Country:US
Mailing Address - Phone:248-946-4664
Mailing Address - Fax:
Practice Address - Street 1:23965 NOVI RD STE 160
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-0203
Practice Address - Country:US
Practice Address - Phone:248-946-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health