Healthcare Provider Details

I. General information

NPI: 1942334669
Provider Name (Legal Business Name): CARLA MILLER MA MSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 THORNAPPLE RV. DR. SE
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

1959 THORNAPPLE RV. DR. SE
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-676-3292
  • Fax: 616-676-3292
Mailing address:
  • Phone: 616-676-3292
  • Fax: 616-676-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLA J MILLER
Title or Position: SOLE PROPRIATOR
Credential: MA, LMSW
Phone: 616-676-3292