Provider Demographics
NPI:1043618085
Name:CAROL MILLER LCSW, L.L.C.
Entity Type:Organization
Organization Name:CAROL MILLER LCSW, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-673-8237
Mailing Address - Street 1:11812 VALLEY GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1666
Mailing Address - Country:US
Mailing Address - Phone:904-673-8237
Mailing Address - Fax:904-564-2507
Practice Address - Street 1:9951 ATLANTIC BLVD STE 263
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6589
Practice Address - Country:US
Practice Address - Phone:904-673-8237
Practice Address - Fax:904-564-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty