Provider Demographics
NPI:1679876726
Name:SA, MIA M (LICSW)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:M
Last Name:SA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:SA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:20006 CEDAR VALLEY RD STE 115
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6478
Mailing Address - Country:US
Mailing Address - Phone:800-550-2105
Mailing Address - Fax:
Practice Address - Street 1:20006 CEDAR VALLEY RD STE 115
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6478
Practice Address - Country:US
Practice Address - Phone:008-550-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical