Provider Demographics
NPI:1063628840
Name:MILLER, CAROL J (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 NEWBURN DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1132
Mailing Address - Country:US
Mailing Address - Phone:301-320-6850
Mailing Address - Fax:
Practice Address - Street 1:7700 LEESBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2615
Practice Address - Country:US
Practice Address - Phone:703-556-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002063103TC0700X
MD03317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical