Healthcare Provider Details

I. General information

NPI: 1194639963
Provider Name (Legal Business Name): ANGELA MILES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAY AVE
HOLLY HILL FL
32117-3429
US

IV. Provider business mailing address

823 MAY AVE
HOLLY HILL FL
32117-3429
US

V. Phone/Fax

Practice location:
  • Phone: 386-852-7318
  • Fax:
Mailing address:
  • Phone: 386-852-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: