Provider Demographics
NPI:1962530253
Name:MILLER, RONELL (LCSW)
Entity type:Individual
Prefix:
First Name:RONELL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:620 GALLATIN PIKE S
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4013
Mailing Address - Country:US
Mailing Address - Phone:615-460-4373
Mailing Address - Fax:615-460-4302
Practice Address - Street 1:620 GALLATIN PIKE S
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4013
Practice Address - Country:US
Practice Address - Phone:615-460-4373
Practice Address - Fax:615-460-4302
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3922131Medicare ID - Type Unspecified