Provider Demographics
NPI:1972011385
Name:MILLER, JANNIE (MSW, CAP, ICADC)
Entity type:Individual
Prefix:
First Name:JANNIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NE 24TH ST APT W412
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1080
Mailing Address - Country:US
Mailing Address - Phone:954-529-6345
Mailing Address - Fax:
Practice Address - Street 1:325 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2612
Practice Address - Country:US
Practice Address - Phone:954-357-8251
Practice Address - Fax:954-357-4898
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0009624101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)