Provider Demographics
NPI:1265607220
Name:MILLER, NORMAN NATHANIEL JR (LADAC, NCAC)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:NATHANIEL
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:LADAC, NCAC
Other - Prefix:
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Mailing Address - Street 1:1420 UNION AVE
Mailing Address - Street 2:STE. 230
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3695
Mailing Address - Country:US
Mailing Address - Phone:901-276-0220
Mailing Address - Fax:901-276-0225
Practice Address - Street 1:1420 UNION AVE
Practice Address - Street 2:STE. 230
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3695
Practice Address - Country:US
Practice Address - Phone:901-276-0220
Practice Address - Fax:901-276-0225
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000411101YA0400X
VANCAC 001390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)