Provider Demographics
NPI:1124818620
Name:HENSON, STACY MICHELLE (LLMSW, CCM, CBIS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:HENSON
Suffix:
Gender:
Credentials:LLMSW, CCM, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9644
Mailing Address - Country:US
Mailing Address - Phone:734-677-7877
Mailing Address - Fax:
Practice Address - Street 1:8787 AQUA LN
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5704
Practice Address - Country:US
Practice Address - Phone:734-234-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511162961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical