Provider Demographics
NPI:1033788054
Name:MILLER, CORRIN (LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:CORRIN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2202
Mailing Address - Country:US
Mailing Address - Phone:443-831-3757
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK RD STE 218-D1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3650
Practice Address - Country:US
Practice Address - Phone:704-800-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA16615OtherNC BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS