Provider Demographics
NPI:1073071627
Name:MILLER, DONNA (MS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3148 EAGLE CREST RD
Mailing Address - Street 2:
Mailing Address - City:FLAT TOP
Mailing Address - State:WV
Mailing Address - Zip Code:25841-9625
Mailing Address - Country:US
Mailing Address - Phone:304-575-3095
Mailing Address - Fax:
Practice Address - Street 1:379 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3141
Practice Address - Country:US
Practice Address - Phone:304-253-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSW031814600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSW031814600OtherSOCIAL WORK