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General NPI Number Information
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NPI Number | 1871068395
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Entity Type | Individual
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Provider Name | ANGELA MILLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 141 DR TT LEWIS CIR
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City | CHARLESTON
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State | MS
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Zip | 38921-2400
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Country | US
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Telephone | 662-647-5535
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Fax |
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Provider Business Mailing Address
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Address Line | 751 CHOCTAW ST
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City | GRENADA
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State | MS
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Zip | 38901-5317
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Country | US
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Telephone | 662-417-7707
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PH4157
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C11387
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License Number State | MS
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