Provider Demographics
NPI:1679246714
Name:MIA ONLINE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MIA ONLINE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER- CLINICAL/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVICIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-409-3120
Mailing Address - Street 1:1259 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1837
Mailing Address - Country:US
Mailing Address - Phone:313-409-3120
Mailing Address - Fax:
Practice Address - Street 1:1259 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1837
Practice Address - Country:US
Practice Address - Phone:313-409-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty