Provider Demographics
NPI:1417484585
Name:MILLER, HALLIE ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HALLIE
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:ROSE
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30902 CLUBHOUSE DR UNIT 23A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2392
Mailing Address - Country:US
Mailing Address - Phone:707-832-7806
Mailing Address - Fax:
Practice Address - Street 1:30902 CLUBHOUSE DR UNIT 23A
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2392
Practice Address - Country:US
Practice Address - Phone:707-832-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical