MEDICARE: DIANA LYNNE MILES MS., LADC, CCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1336556166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LYNNE MILES MS., LADC, CCS

Provider Business Mailing Address
First Line	:	52 TOP HILL RD
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-3544
Country	:	US
Telephone Number	:	802-376-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 TOP HILL RD
Second Line	:
City	:	NAPLES
State	:	ME
Zip	:	04055-3544
Country	:	US
Telephone Number	:	802-376-0410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/15/2020

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