Provider Demographics
NPI:1477784635
Name:MINGLE, MIRANDA JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JOY
Last Name:MINGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:JOY
Other - Last Name:EGGLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:610 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2589
Mailing Address - Country:US
Mailing Address - Phone:276-525-1587
Mailing Address - Fax:276-525-1609
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1587
Practice Address - Fax:276-525-1609
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical