Provider Demographics
NPI:1982182663
Name:MILLER, DANIELLE (LCDC, CDCA, PEER CER)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCDC, CDCA, PEER CER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1419
Mailing Address - Country:US
Mailing Address - Phone:567-209-3330
Mailing Address - Fax:
Practice Address - Street 1:1628 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1430
Practice Address - Country:US
Practice Address - Phone:937-802-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHLCDCII.161957101YA0400X
OH101Y00000X
OHCDCA.171804101YA0400X
OH423753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH545122Medicaid