Healthcare Provider Details

I. General information

NPI: 1730018334
Provider Name (Legal Business Name): KRISTIN JENSEN MILLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 PETERSBURG ST
CHESTER VA
23831-5027
US

IV. Provider business mailing address

6655 SANTA BARBARA RD UNIT 8574
ELKRIDGE MD
21075-7523
US

V. Phone/Fax

Practice location:
  • Phone: 571-215-8180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903004925
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: