Healthcare Provider Details

I. General information

NPI: 1831571710
Provider Name (Legal Business Name): NADINE VALERIE VAZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADINE VALERIE JOHNSON LMSW

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3493 WOODS EDGE STE 103
OKEMOS MI
48864-5911
US

IV. Provider business mailing address

2820 BAKER RD STE 100
DEXTER MI
48130-1196
US

V. Phone/Fax

Practice location:
  • Phone: 517-886-3707
  • Fax: 517-349-1973
Mailing address:
  • Phone: 734-580-2920
  • Fax: 734-580-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081893
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: