Provider Demographics
NPI:1275346918
Name:MILES, AMANDA SYMONNE (CDCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SYMONNE
Last Name:MILES
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SPRUCEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-4240
Mailing Address - Country:US
Mailing Address - Phone:513-801-0601
Mailing Address - Fax:
Practice Address - Street 1:12115 SHERATON LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1613
Practice Address - Country:US
Practice Address - Phone:513-628-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)