Basic Information
| Provider Information | |||||||||
| NPI: | 1235601550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | DAKOTA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | LABADIEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703722424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858706669 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1418 TIGER DR | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703014337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854494055 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2018 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | 6820 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 6820 | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.