Provider Demographics
NPI:1881939502
Name:MILES, SOCORRO (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:SOCORRO
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 BANNINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1341
Mailing Address - Country:US
Mailing Address - Phone:919-288-9555
Mailing Address - Fax:
Practice Address - Street 1:6419 BANNINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1341
Practice Address - Country:US
Practice Address - Phone:704-533-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0090441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical