Provider Demographics
NPI:1811934110
Name:MILES, LAURIE D (MS, LLP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:MILES
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W WACKERLY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4703
Mailing Address - Country:US
Mailing Address - Phone:989-839-6565
Mailing Address - Fax:989-839-5794
Practice Address - Street 1:728 W WACKERLY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4703
Practice Address - Country:US
Practice Address - Phone:989-839-6565
Practice Address - Fax:989-839-5794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010102501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical