Provider Demographics
NPI:1851782478
Name:MILLER, CAROL ANN (PASTORAL COUNSELOR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 NEAL RD
Mailing Address - Street 2:
Mailing Address - City:KINMUNDY
Mailing Address - State:IL
Mailing Address - Zip Code:62854-2746
Mailing Address - Country:US
Mailing Address - Phone:618-245-2517
Mailing Address - Fax:618-551-2753
Practice Address - Street 1:8690 NEAL RD
Practice Address - Street 2:
Practice Address - City:KINMUNDY
Practice Address - State:IL
Practice Address - Zip Code:62854-2746
Practice Address - Country:US
Practice Address - Phone:618-245-2517
Practice Address - Fax:618-551-2753
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty