Provider Demographics
NPI:1336858539
Name:MIRIANI, CHARLES WILLIAM
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:MIRIANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 CHENLOT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4303
Mailing Address - Country:US
Mailing Address - Phone:248-978-9826
Mailing Address - Fax:
Practice Address - Street 1:29451 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2251
Practice Address - Country:US
Practice Address - Phone:248-978-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)