Provider Demographics
NPI:1831571710
Name:VAZ, NADINE VALERIE (LMSW)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:VALERIE
Last Name:VAZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:VALERIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2820 BAKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1196
Mailing Address - Country:US
Mailing Address - Phone:734-580-2920
Mailing Address - Fax:734-580-2922
Practice Address - Street 1:3493 WOODS EDGE
Practice Address - Street 2:STE 103
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5911
Practice Address - Country:US
Practice Address - Phone:517-886-3707
Practice Address - Fax:517-349-1973
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010818931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical