Healthcare Provider Details

I. General information

NPI: 1780345603
Provider Name (Legal Business Name): HEATHER M MILLER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER M SMITH

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 STANAFORD RD
BECKLEY WV
25801-3141
US

IV. Provider business mailing address

379 STANAFORD RD
BECKLEY WV
25801-3141
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-3000
  • Fax: 304-929-2038
Mailing address:
  • Phone: 304-253-3000
  • Fax: 304-929-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: