Healthcare Provider Details

I. General information

NPI: 1306114814
Provider Name (Legal Business Name): DOLORES JEAN MILLER MASTER SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN MILLER MASTER SOCIAL WORKER

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 OLD LANSING RD
LANSING MI
48917-4392
US

IV. Provider business mailing address

444 CORNELL DR
BATTLE CREEK MI
49017-4614
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-2980
  • Fax:
Mailing address:
  • Phone: 269-830-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-01286
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: