Provider Demographics
NPI:1053679183
Name:BOBZIEN, LORETTA ANN (LMSW CAADC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:BOBZIEN
Suffix:
Gender:F
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5033
Mailing Address - Country:US
Mailing Address - Phone:517-610-6816
Mailing Address - Fax:517-721-7870
Practice Address - Street 1:239 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5033
Practice Address - Country:US
Practice Address - Phone:517-610-6816
Practice Address - Fax:517-721-7870
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857451041C0700X
MIC-02982101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)