Provider Demographics
NPI:1235520107
Name:GILES, GENEVA ANN (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:GENEVA
Middle Name:ANN
Last Name:GILES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RICHTON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3503
Mailing Address - Country:US
Mailing Address - Phone:313-428-7749
Mailing Address - Fax:
Practice Address - Street 1:2900 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-308-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097597104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker