Healthcare Provider Details

I. General information

NPI: 1619201498
Provider Name (Legal Business Name): CORTNEY ANNE MILLER LCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 03/21/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 S BLOOMINGTON ST STE B
GREENCASTLE IN
46135-2269
US

IV. Provider business mailing address

1958 S COUNTY ROAD 400 W
GREENCASTLE IN
46135-8282
US

V. Phone/Fax

Practice location:
  • Phone: 919-600-2778
  • Fax: 866-544-8850
Mailing address:
  • Phone: 919-600-2778
  • Fax: 866-544-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001194A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005686A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: