Provider Demographics
NPI:1265529275
Name:MILLER, JEFFREY WOULFE (LCADC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WOULFE
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SOUTH CHURCH STREET
Mailing Address - Street 2:STE 105
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21257
Mailing Address - Country:US
Mailing Address - Phone:410-848-9244
Mailing Address - Fax:
Practice Address - Street 1:40 S CHURCH ST
Practice Address - Street 2:STE 105
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5435
Practice Address - Country:US
Practice Address - Phone:410-848-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA274101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
64721501OtherCARFIRST HMO
R5830051OtherCAREFIRST GHMSI