Provider Demographics
NPI:1548601487
Name:MIELKE, OLIVIA MARIE (MA, LPC, NCC, CAADC)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:MARIE
Last Name:MIELKE
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CAADC
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:MARIE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:13157 LAKE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2238
Mailing Address - Country:US
Mailing Address - Phone:734-819-0747
Mailing Address - Fax:734-423-0233
Practice Address - Street 1:13157 LAKE POINT BLVD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-2238
Practice Address - Country:US
Practice Address - Phone:734-819-0747
Practice Address - Fax:734-423-0233
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014927101Y00000X, 101YM0800X, 101YP2500X
MIC03439101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548601487Medicaid