MEDICARE: LAURITA MILLER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0531-1510C	AL

General Provider Information

NPI Number	:	1255717948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURITA MILLER LLC

Provider Business Mailing Address
First Line	:	3 OFFICE PARK CIR STE 115
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2534
Country	:	US
Telephone Number	:	205-912-2007
Fax Number	:	205-945-1890

Provider Business Practice Location Address
First Line	:	3 OFFICE PARK CIR STE 115
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2534
Country	:	US
Telephone Number	:	205-912-2007
Fax Number	:	205-945-1890

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LAURITA MILLER
Credential	:	LCSW
Telephone Number	:	205-267-2945

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/04/2015

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