Provider Demographics
NPI:1306114814
Name:MILLER, DOLORES JEAN (MASTER SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORKER
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTER SOCIAL WORKER
Mailing Address - Street 1:444 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-4614
Mailing Address - Country:US
Mailing Address - Phone:269-830-0491
Mailing Address - Fax:
Practice Address - Street 1:3410 OLD LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4392
Practice Address - Country:US
Practice Address - Phone:517-657-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01286101YA0400X
MI68010986261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical