Doctor Name: | WADE RANDOLPH STITT |
NPI Number: | 1013139872 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A.C., L.P.C. |
License Number: | 6401009358 |
Business Practice Address: | 140 Michigan Ave W Battle Creek, MI - 490173602 |
Business Phone Number: | 2694416079 |
Business Fax Number: | 2699661281 |
Mailing Address: | 735 Knollwood Dr, BATTLE CREEK |
State: | MI |
Postal Code: | 490154611 |
Phone Number: | 2694416079 |
Fax Number: | 2699661281 |
NPI Enumeration Date: | 05/02/2007 |
NPI Last Update Date: | 03/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401009358 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |