Provider Demographics
NPI:1528221934
Name:ETHERINGTON, MIRANDA LOUISE (CT)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:LOUISE
Last Name:ETHERINGTON
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODMAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3497
Mailing Address - Country:US
Mailing Address - Phone:937-223-1781
Mailing Address - Fax:937-424-8656
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3497
Practice Address - Country:US
Practice Address - Phone:937-223-1781
Practice Address - Fax:937-424-8656
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700385-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor