=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437514080
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICKIA MILLER LADC, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2015
-----------------------------------------------------
Last Update Date | 07/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 DEAR MEADOW DRIVE
-----------------------------------------------------
City | BLOOMFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-805-0245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 CROSSROADS PLZ STE 180
-----------------------------------------------------
City | WEST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06117-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-805-0245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 12263
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 1121
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------