Provider Demographics
NPI:1881711307
Name:HALLAWAY, MONIRA LOUISE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MONIRA
Middle Name:LOUISE
Last Name:HALLAWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10957 WYNNS RD
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8110
Mailing Address - Country:US
Mailing Address - Phone:734-776-7205
Mailing Address - Fax:
Practice Address - Street 1:2035 HOGBACK RD STE 101
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9487
Practice Address - Country:US
Practice Address - Phone:734-776-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010853211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical