Healthcare Provider Details

I. General information

NPI: 1881570745
Provider Name (Legal Business Name): ALEXANDRIA MILLER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 STATE ROUTE 39
SHELBY OH
44875-9466
US

IV. Provider business mailing address

2775 STATE ROUTE 39
SHELBY OH
44875-9466
US

V. Phone/Fax

Practice location:
  • Phone: 419-747-3322
  • Fax:
Mailing address:
  • Phone: 419-747-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191670
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2513112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: