Provider Demographics
NPI:1699809244
Name:MILLER, SANDRA (LMSW, ACSW, CAAC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW, ACSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 WENDY CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3175
Mailing Address - Country:US
Mailing Address - Phone:734-709-1232
Mailing Address - Fax:734-998-1451
Practice Address - Street 1:202 E WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2017
Practice Address - Country:US
Practice Address - Phone:734-709-1232
Practice Address - Fax:734-998-1451
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077262101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor