Provider Demographics
NPI:1942334669
Name:CARLA MILLER MA MSW
Entity Type:Organization
Organization Name:CARLA MILLER MA MSW
Other - Org Name:CARLA MILLER MA MSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMSW
Authorized Official - Phone:616-676-3292
Mailing Address - Street 1:1959 THORNAPPLE RV. DR. SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-676-3292
Mailing Address - Fax:616-676-3292
Practice Address - Street 1:1959 THORNAPPLE RV. DR. SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-676-3292
Practice Address - Fax:616-676-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP27640Medicare ID - Type UnspecifiedSOCIAL WORK