Provider Demographics
NPI:1225785090
Name:MILLER, RYAN AMANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:AMANDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ATLANTA AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5173
Mailing Address - Country:US
Mailing Address - Phone:910-546-3906
Mailing Address - Fax:
Practice Address - Street 1:217 ATLANTA AVE APT 2D
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-5173
Practice Address - Country:US
Practice Address - Phone:910-546-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C0126531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical