Provider Demographics
NPI:1528099009
Name:MILLER, LAURITA MULLINS (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LAURITA
Middle Name:MULLINS
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STRATSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2710
Mailing Address - Country:US
Mailing Address - Phone:205-267-2945
Mailing Address - Fax:205-945-1890
Practice Address - Street 1:1109 TOWNHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080
Practice Address - Country:US
Practice Address - Phone:205-267-2945
Practice Address - Fax:205-945-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0531-1510C1041C0700X
HI40291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL98835OtherBCBS
AL98835OtherBCBS