Healthcare Provider Details

I. General information

NPI: 1376243774
Provider Name (Legal Business Name): LAURA MILLER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9954 N MAIN ST UNIT 1
BERLIN MD
21811-1299
US

IV. Provider business mailing address

9954 N MAIN ST UNIT 1
BERLIN MD
21811-1299
US

V. Phone/Fax

Practice location:
  • Phone: 410-973-2567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP13615
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: