Provider Demographics
NPI:1285703843
Name:WILEY, EILEEN L (MSW)
Entity type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:L
Last Name:WILEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 STEWART RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5304
Mailing Address - Country:US
Mailing Address - Phone:734-240-1760
Mailing Address - Fax:734-240-1780
Practice Address - Street 1:700 STEWART RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5304
Practice Address - Country:US
Practice Address - Phone:734-240-1760
Practice Address - Fax:734-240-1780
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071856101YA0400X
MI1-02018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008951790OtherBCBS
MIOM54180006Medicare ID - Type Unspecified