Healthcare Provider Details

I. General information

NPI: 1235060716
Provider Name (Legal Business Name): MICHAELA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICKEY MILLER

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4998 W BROAD ST STE 104
COLUMBUS OH
43228-1647
US

IV. Provider business mailing address

377 W HUBBARD AVE
COLUMBUS OH
43215-1383
US

V. Phone/Fax

Practice location:
  • Phone: 888-890-3779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.196106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: