Healthcare Provider Details

I. General information

NPI: 1831824788
Provider Name (Legal Business Name): KIMBERLY A MIER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48075-2436
US

IV. Provider business mailing address

28211 SOUTHFIELD RD # 426
LATHRUP VILLAGE MI
48076-7047
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 586-585-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022973
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: