Provider Demographics
NPI:1902440142
Name:MILLER, ROSE DIANE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4245
Mailing Address - Country:US
Mailing Address - Phone:352-379-2829
Mailing Address - Fax:352-379-2843
Practice Address - Street 1:1208 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4245
Practice Address - Country:US
Practice Address - Phone:352-379-2829
Practice Address - Fax:352-379-2843
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-2429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH-2429OtherLICENSED MENTAL HEALTH COUNSELOR