Individual
MYSHIA VENISE LILES-MOULTRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
5030 NORTHWIND DR STE 101, EAST LANSING, MI 48823-5034
(517) 333-1499
Mailing address
4642 S HAGADORN RD APT E19, EAST LANSING, MI 48823-5326
(989) 522-2580
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6451021996
MI
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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