Healthcare Provider Details

I. General information

NPI: 1932338092
Provider Name (Legal Business Name): NORMA JOAN MILLER LCPC, RDDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 N LAKE SHORE DR APT. 1206B
CHICAGO IL
60613-3408
US

IV. Provider business mailing address

3950 N LAKE SHORE DR APT. 1206B
CHICAGO IL
60613-3408
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-1452
  • Fax: 847-455-0744
Mailing address:
  • Phone: 773-883-1452
  • Fax: 847-455-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26099
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180000610
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180000610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: