Provider Demographics
NPI:1811927742
Name:MILLER, PEGGY P (LCSW)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:P
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:P
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13 BARBER DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6483
Mailing Address - Country:US
Mailing Address - Phone:501-580-9800
Mailing Address - Fax:501-851-1339
Practice Address - Street 1:4 SHACKLEFORD PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1843
Practice Address - Country:US
Practice Address - Phone:501-580-9800
Practice Address - Fax:501-851-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1209-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V710OtherMEDICARE PTAN
AR5V710OtherMEDICARE PTAN
AR5W868Medicare ID - Type Unspecified