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General NPI Number Information
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NPI Number | 1124488275
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Entity Type | Individual
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Provider Name | BRANDON D MILLER PCC, LICDC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 5211 MAHONING AVE STE 370
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City | AUSTINTOWN
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State | OH
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Zip | 44515-1853
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Country | US
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Telephone | 330-792-4724
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Fax | 330-792-1848
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Provider Business Mailing Address
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Address Line | 2591 WILSON SHARPSVILLE RD
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City | CORTLAND
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State | OH
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Zip | 44410-9406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 131009
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.1300036
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License Number State | OH
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