Provider Demographics
NPI:1093992307
Name:HARGROVE-MILLER, MALINDA DELORES (LCSW, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:DELORES
Last Name:HARGROVE-MILLER
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 GLENAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-2031
Mailing Address - Country:US
Mailing Address - Phone:804-233-2831
Mailing Address - Fax:804-233-2831
Practice Address - Street 1:3127 GLENAN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-2031
Practice Address - Country:US
Practice Address - Phone:804-233-2831
Practice Address - Fax:804-233-2831
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710000989101YA0400X
VA09040054671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)