Provider Demographics
NPI:1811017924
Name:AUDIA, JANET ELAINE (LBA-SW)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ELAINE
Last Name:AUDIA
Suffix:
Gender:F
Credentials:LBA-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21112 BAYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1196
Mailing Address - Country:US
Mailing Address - Phone:586-775-6826
Mailing Address - Fax:
Practice Address - Street 1:71 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5543
Practice Address - Country:US
Practice Address - Phone:586-469-6528
Practice Address - Fax:586-466-4131
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802058463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health