Healthcare Provider Details

I. General information

NPI: 1932253218
Provider Name (Legal Business Name): BONNIE CHRISTINE MIRIANI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE CHRISTINE MARTINEZ LMSW

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LAKE LANSING RD STE 120
LANSING MI
48912
US

IV. Provider business mailing address

1033 HEALTHCARE DR
CHARLOTTE MI
48813-1058
US

V. Phone/Fax

Practice location:
  • Phone: 810-494-7180
  • Fax: 810-215-1334
Mailing address:
  • Phone: 517-541-2673
  • Fax: 517-543-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801082008
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082008
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: