Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1013572890 |
---|---|
Provider Name | Amy L Miller |
First Address | Fairbanks, AK 99701-4707 |
Second Address | North Pole, AK 99705-5036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2019 |
Last Update Date | 06/03/2020 |