NPIMap

Organization Active NPI

Stonebrook Counseling Associates PLLC

  • Social Worker
  • Livonia, MI
National Provider Identifier
1861571846
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6801033601 Issued in MI
Legal business name
STONEBROOK COUNSELING ASSOCIATES PLLC
Practice address
37799 Professional Center Dr Ste 106
Livonia, MI 48754
Phone
(248) 343-4695
NPI assigned
Nov 2, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nancy Dahms Petrides, LMSWNPI 1902869233
Title
Clinician Owner
Phone
(248) 343-4695

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 104100000X 6801033601 MI Primary

Addresses

Primary practice location

37799 Professional Center Dr Ste 106
Livonia, MI 48754

Mailing address

37799 Professional Center Dr Ste 106
Livonia, MI 48754
Phone (248) 343-4695

Other names 1

  • PLLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040903000644 MI Part B Supplier - Clinic/Group Practice 1951377688 Receives reassigned benefits from 2 practitioners
Practice locations: Ann Arbor, MI; Livonia, MI; Royal Oak, MI

National Provider Directory

National Provider Directory

Locations

2311 E Stadium Blvd
Ste 212
Ann Arbor, MI 48104
Phone (734) 222-8285

37677 Professional Center Dr
Ste 135C
Livonia, MI 48154
Phone (248) 238-0236

25600 Woodward Ave
Ste 105
Royal Oak, MI 48067
Phone (248) 343-4695

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861571846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37799 PROFESSIONAL CENTER DR STE 106",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "48754",
            "telephone_number": "248-343-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37799 PROFESSIONAL CENTER DR STE 106",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "48754",
            "telephone_number": "248-343-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBROOK COUNSELING ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRIDES",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "DAHMS",
        "authorized_official_title_or_position": "CLINICIAN OWNER",
        "authorized_official_telephone_number": "248-343-4695",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801033601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.