Healthcare Provider Details

I. General information

NPI: 1215120092
Provider Name (Legal Business Name): CHRISTINE MARIE MIELOCH MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3740
  • Fax: 810-257-3791
Mailing address:
  • Phone: 810-257-3740
  • Fax: 810-496-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801064865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: