Healthcare Provider Details

I. General information

NPI: 1023881620
Provider Name (Legal Business Name): DELESLINE MILLER ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. DEE MILLER

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 OVERLAND TRL
NORTH CHARLESTON SC
29420-9024
US

IV. Provider business mailing address

5414 OVERLAND TRL
NORTH CHARLESTON SC
29420-9024
US

V. Phone/Fax

Practice location:
  • Phone: 843-437-4597
  • Fax:
Mailing address:
  • Phone: 843-437-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: