Provider Demographics
NPI:1104070697
Name:MILLER, MEGAN REBECCA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:REBECCA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:REBECCA
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 BRIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9514
Mailing Address - Country:US
Mailing Address - Phone:501-771-8502
Mailing Address - Fax:501-771-8511
Practice Address - Street 1:21 BRIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9514
Practice Address - Country:US
Practice Address - Phone:501-771-8502
Practice Address - Fax:501-771-8511
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1981-M104100000X
AR2308-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172039795Medicaid