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NPI Code Detail

MEDICARE: MRS. DIANA MILLER LCSW

MEDICARE: MRS. DIANA MILLER LCSW
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
11041C0700XClinical Social WorkerP010875NC
21041C0700XClinical Social WorkerC012810NC

General Provider Information

NPI Number : 1821584715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANA MILLER LCSW
Provider Business Mailing Address
First Line : 3505 VILLAGE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-4513
Country : US
Telephone Number : 910-500-1800
Fax Number :
Provider Business Practice Location Address
First Line : 3505 VILLAGE DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-4513
Country : US
Telephone Number : 910-500-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 04/07/2021

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