Provider Demographics
NPI:1609504828
Name:MINTON, MIRANDA ELAINE (LCSWA)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:ELAINE
Last Name:MINTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 11TH AVENUE DR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8336
Mailing Address - Country:US
Mailing Address - Phone:828-695-6500
Mailing Address - Fax:828-695-4729
Practice Address - Street 1:3050 11TH AVENUE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8336
Practice Address - Country:US
Practice Address - Phone:828-695-6500
Practice Address - Fax:828-695-4729
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P0179551041C0700X
NCP0179551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical