Provider Demographics
NPI:1912366576
Name:MILLER, JENNIFER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8318 SHAGREEN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5126
Mailing Address - Country:US
Mailing Address - Phone:410-596-3436
Mailing Address - Fax:
Practice Address - Street 1:9850 LORI RD STE 101
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6758
Practice Address - Country:US
Practice Address - Phone:804-621-4034
Practice Address - Fax:804-621-4091
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13034104100000X
VA09040101151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker