Provider Demographics
NPI:1063859635
Name:ERICA MILLER COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:ERICA MILLER COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:NICCOLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-508-3306
Mailing Address - Street 1:PO BOX 5834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-5834
Mailing Address - Country:US
Mailing Address - Phone:850-508-3306
Mailing Address - Fax:
Practice Address - Street 1:2892 E PARK AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3445
Practice Address - Country:US
Practice Address - Phone:850-508-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty