Provider Demographics
NPI:1720853583
Name:METREVELI, LUDMILA (LCSW)
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:METREVELI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 OAK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3740
Mailing Address - Country:US
Mailing Address - Phone:248-238-7306
Mailing Address - Fax:
Practice Address - Street 1:30500 NORTHWESTERN HWY STE 316
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3159
Practice Address - Country:US
Practice Address - Phone:248-539-8781
Practice Address - Fax:248-539-8940
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011173051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical