Provider Demographics
NPI:1710218797
Name:PARHAM, MIA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:NICOLE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MIA
Other - Middle Name:NICOLE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 MOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-757-5500
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-6383
Practice Address - Fax:215-823-4545
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000080281041C0700X
DEQ1-00015461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical