Provider Demographics
NPI:1922214568
Name:OVERHOLT, MILES H III (DSW)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:H
Last Name:OVERHOLT
Suffix:III
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2349
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-5349
Mailing Address - Country:US
Mailing Address - Phone:856-786-9355
Mailing Address - Fax:856-786-8642
Practice Address - Street 1:106 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-4378
Practice Address - Country:US
Practice Address - Phone:856-786-9355
Practice Address - Fax:856-786-8642
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ756OtherMARRIAGE & FAMILY THERAPY