Healthcare Provider Details

I. General information

NPI: 1255678470
Provider Name (Legal Business Name): JOHN MICHAEL MILLER L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21641 RIDGETOP CIR STE 210
STERLING VA
20166-6597
US

IV. Provider business mailing address

21641 RIDGETOP CIR STE 210
STERLING VA
20166-6597
US

V. Phone/Fax

Practice location:
  • Phone: 571-680-3861
  • Fax: 571-258-3032
Mailing address:
  • Phone: 571-680-3861
  • Fax: 571-258-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: