Provider Demographics
NPI:1043659600
Name:MICKLES-BURNES, LEONA (ACSW, PHD, LMSW)
Entity type:Individual
Prefix:DR
First Name:LEONA
Middle Name:
Last Name:MICKLES-BURNES
Suffix:
Gender:F
Credentials:ACSW, PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 15 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4853
Mailing Address - Country:US
Mailing Address - Phone:586-264-3692
Mailing Address - Fax:586-939-5953
Practice Address - Street 1:2122 15 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4853
Practice Address - Country:US
Practice Address - Phone:586-264-3692
Practice Address - Fax:586-939-5953
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010467641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical