Provider Demographics
NPI:1780038059
Name:MILLER, EDNA (CADC)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5254
Mailing Address - Country:US
Mailing Address - Phone:775-883-9933
Mailing Address - Fax:775-883-9934
Practice Address - Street 1:841 E SECOND ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5254
Practice Address - Country:US
Practice Address - Phone:775-883-9933
Practice Address - Fax:775-883-9934
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00269-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)