Healthcare Provider Details

I. General information

NPI: 1285703843
Provider Name (Legal Business Name): EILEEN L WILEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STEWART RD SUITE 105
MONROE MI
48162-5304
US

IV. Provider business mailing address

700 STEWART RD SUITE 105
MONROE MI
48162-5304
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1760
  • Fax: 734-240-1780
Mailing address:
  • Phone: 734-240-1760
  • Fax: 734-240-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801071856
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1-02018
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: