Provider Demographics
NPI:1568942985
Name:MILLER, CHARLES FRANKLIN (ASW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3822
Mailing Address - Country:US
Mailing Address - Phone:562-417-1017
Mailing Address - Fax:
Practice Address - Street 1:916 N WESTERN AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2407
Practice Address - Country:US
Practice Address - Phone:866-519-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW76376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health