Provider Demographics
NPI:1497752984
Name:MILLERLINE, THEODORA ANNE (LPCMH)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:ANNE
Last Name:MILLERLINE
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3309
Mailing Address - Country:US
Mailing Address - Phone:302-674-1600
Mailing Address - Fax:302-674-1005
Practice Address - Street 1:1155 WALKER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6539
Practice Address - Country:US
Practice Address - Phone:302-674-1600
Practice Address - Fax:302-674-1005
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional