Provider Demographics
NPI:1730364902
Name:MILLER, DIANA (LICDC-CS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6895
Mailing Address - Country:US
Mailing Address - Phone:330-687-4731
Mailing Address - Fax:
Practice Address - Street 1:186 PINEHURST RD
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1135
Practice Address - Country:US
Practice Address - Phone:330-687-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.95436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318508Medicaid