Provider Demographics
NPI:1336556166
Name:MILES, DIANA LYNNE (MS, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:MILES
Suffix:
Gender:F
Credentials:MS, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TOP HILL RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-3544
Mailing Address - Country:US
Mailing Address - Phone:802-376-0410
Mailing Address - Fax:
Practice Address - Street 1:52 TOP HILL RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055-3544
Practice Address - Country:US
Practice Address - Phone:802-376-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE2534Medicare PIN