Individual
MR. THEODORE PHILIP MILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADAC II
Contact information
Practice address
1355 W BLOOMFIELD RD, BLOOMINGTON, IN 47403-2051
(812) 558-0574
Mailing address
1355 W BLOOMFIELD RD, BLOOMINGTON, IN 47403-2051
(812) 558-0574
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C2-1990
IN
Other
Enumeration date
03/18/2021
Last updated
03/18/2021
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