Provider Demographics
NPI:1932253218
Name:MIRIANI, BONNIE CHRISTINE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:CHRISTINE
Last Name:MIRIANI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:CHRISTINE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1033 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1058
Mailing Address - Country:US
Mailing Address - Phone:517-541-2673
Mailing Address - Fax:517-543-2656
Practice Address - Street 1:1701 LAKE LANSING RD STE 120
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:810-215-1334
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20548OtherBLUE CROSS BLUE SHIELD
MIN97350001Medicare ID - Type UnspecifiedINDIVIDUAL IDENTIFIER
MI20548OtherBLUE CROSS BLUE SHIELD