Provider Demographics
NPI:1790510964
Name:MILLER, JADE BARBARA (SUDRC)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:BARBARA
Last Name:MILLER
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SERPENTINE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4758
Mailing Address - Country:US
Mailing Address - Phone:925-444-7040
Mailing Address - Fax:
Practice Address - Street 1:1020 SERPENTINE LN STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4758
Practice Address - Country:US
Practice Address - Phone:925-444-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)