Provider Demographics
NPI:1013206861
Name:FORD, MIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:701 LOYOLA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1912
Mailing Address - Country:US
Mailing Address - Phone:504-558-9595
Mailing Address - Fax:
Practice Address - Street 1:701 LOYOLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1912
Practice Address - Country:US
Practice Address - Phone:504-558-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9980171M00000X, 104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker