Provider Demographics
NPI:1528786852
Name:STOKES, KIMBERLY LAUREN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:STOKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3343
Mailing Address - Country:US
Mailing Address - Phone:248-302-5788
Mailing Address - Fax:
Practice Address - Street 1:27172 WOODWARD AVE STE 200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0965
Practice Address - Country:US
Practice Address - Phone:248-546-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009556103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling