Provider Demographics
NPI:1811101892
Name:DALTON, STACEY MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:DALTON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 MARION DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3237
Mailing Address - Country:US
Mailing Address - Phone:586-246-8566
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD STE 110
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811101892Medicaid