Healthcare Provider Details

I. General information

NPI: 1528099009
Provider Name (Legal Business Name): LAURITA MULLINS MILLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 TOWNHOUSE ROAD
HELENA AL
35080
US

IV. Provider business mailing address

104 STRATSHIRE LN
PELHAM AL
35124-2710
US

V. Phone/Fax

Practice location:
  • Phone: 205-267-2945
  • Fax: 205-945-1890
Mailing address:
  • Phone: 205-267-2945
  • Fax: 205-945-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0531-1510C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4029
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: