Provider Demographics
NPI:1063546950
Name:MILLER, CAROLE L (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 SHAKER DRIVE
Mailing Address - Street 2:SUITE 326
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21150
Mailing Address - Country:US
Mailing Address - Phone:443-545-1611
Mailing Address - Fax:443-632-3946
Practice Address - Street 1:9780 PATUXENT WOODS DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1526
Practice Address - Country:US
Practice Address - Phone:410-313-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15448OtherLCSW - BOARD OF BEHAVIORAL HEALTH EXAMINERS
MD417680400Medicaid