Provider Demographics
NPI:1629564448
Name:MILLER, DERRIUS TEREL (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:DERRIUS
Middle Name:TEREL
Last Name:MILLER
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6634
Mailing Address - Country:US
Mailing Address - Phone:601-668-2162
Mailing Address - Fax:
Practice Address - Street 1:125 BENT CREEK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6634
Practice Address - Country:US
Practice Address - Phone:601-668-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC79081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical