Provider Demographics
NPI:1275006108
Name:MILLER, HEIDI NICOLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SHONEY DR SW STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5450
Mailing Address - Country:US
Mailing Address - Phone:256-883-3231
Mailing Address - Fax:256-883-9577
Practice Address - Street 1:810 SHONEY DR SW STE 120
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5450
Practice Address - Country:US
Practice Address - Phone:256-883-3231
Practice Address - Fax:256-883-9577
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4110C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical