Provider Demographics
NPI:1083310163
Name:MILES, TA'TIANA NICOLE
Entity Type:Individual
Prefix:
First Name:TA'TIANA
Middle Name:NICOLE
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 FARNSWORTH LN APT 5204
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5803
Mailing Address - Country:US
Mailing Address - Phone:202-455-8437
Mailing Address - Fax:
Practice Address - Street 1:13800 FARNSWORTH LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5802
Practice Address - Country:US
Practice Address - Phone:202-455-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29586104100000X
DCLG50083841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker