Provider Demographics
NPI:1770564635
Name:MILLER, CONNIE GENE (LMSW CADC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:GENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1508
Mailing Address - Country:US
Mailing Address - Phone:509-927-0497
Mailing Address - Fax:
Practice Address - Street 1:1115 B ST
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851
Practice Address - Country:US
Practice Address - Phone:208-686-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC 1088005101YA0400X
IDLMSW 25983104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker