Provider Demographics
NPI:1366431587
Name:FABICK, STEPHEN DILLON (EDD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DILLON
Last Name:FABICK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3881
Mailing Address - Country:US
Mailing Address - Phone:248-258-9288
Mailing Address - Fax:248-258-5187
Practice Address - Street 1:640 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3881
Practice Address - Country:US
Practice Address - Phone:248-258-9288
Practice Address - Fax:248-258-5187
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI99127OtherMANAGED HEALTH NETWORK
MI0 F3 4657OtherBCBS OF MICHIGAN
MI0001011251OtherMHN (VENDOR #)
MI56941OtherCIGNA BEHAVIORAL HEALTH
MI0001011251OtherMHN (VENDOR #)