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General NPI Number Information
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NPI Number | 1770216103
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Entity Type | Individual
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Provider Name | TABATHA SUE MILLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 9701 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2123
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Country | US
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Telephone | 717-449-0458
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Fax |
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Provider Business Mailing Address
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Address Line | 10 REMINGTON DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8202
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Country | US
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Telephone | 501-410-1567
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7815-C
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License Number State | AR
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