Provider Demographics
NPI:1144585787
Name:SIBILSKI, LIA
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:SIBILSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD STE 311
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6821
Mailing Address - Country:US
Mailing Address - Phone:517-346-8275
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:5303 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-346-8062
Practice Address - Fax:517-346-8011
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092071104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker