Provider Demographics
NPI:1083612204
Name:MILLER, DAVID B (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 BUFFAT MILL RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-3117
Mailing Address - Country:US
Mailing Address - Phone:865-329-2909
Mailing Address - Fax:
Practice Address - Street 1:6 6TH ST
Practice Address - Street 2:SUITE 205 CENTRAL BUILDING
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-2237
Practice Address - Country:US
Practice Address - Phone:423-968-2225
Practice Address - Fax:423-968-2225
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW11011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3696440Medicaid
TN3696443Medicare ID - Type Unspecified
TN3696440Medicaid