Provider Demographics
NPI:1114682127
Name:MIELE-HALL, JENNIE ANTOINETTE (CADC-I)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:ANTOINETTE
Last Name:MIELE-HALL
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ROBIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28333-9141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 E ASH ST STE 201
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:919-267-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)