Basic Information
| Provider Information | |||||||||
| NPI: | 1649926999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILAM | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | DARLENE | ||||||||
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| Credential: | MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 568 JESSE FORK RD | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251777475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813412500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2157 GREENBRIER ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253119623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043445924 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2022 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.