Provider Demographics
NPI:1588046668
Name:MILLER, MAEVEN ELIZABETH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MAEVEN
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:MAEVEN
Other - Middle Name:ELIZABETH
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 MCCOY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4931
Mailing Address - Country:US
Mailing Address - Phone:304-769-9577
Mailing Address - Fax:
Practice Address - Street 1:2001 MCCOY RD STE 105
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4931
Practice Address - Country:US
Practice Address - Phone:304-769-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66351041C0700X
TN9345101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker