Healthcare Provider Details

I. General information

NPI: 1427757285
Provider Name (Legal Business Name): SAMANTHA MILLER CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 STAUNTON DR
WESTON WV
26452-5604
US

IV. Provider business mailing address

149 STAUNTON DR
WESTON WV
26452-5604
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-5510
  • Fax:
Mailing address:
  • Phone: 304-269-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3172
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: