Provider Demographics
NPI:1053652149
Name:MILLER, JEFFREY LEE (MS,LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS,LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 COLUMBUS CIR APT A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3940
Mailing Address - Country:US
Mailing Address - Phone:239-248-2734
Mailing Address - Fax:
Practice Address - Street 1:5013 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:910-796-6868
Practice Address - Fax:910-796-6869
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 5430101YA0400X
FLMH11687101YM0800X
NC14163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health