Provider Demographics
NPI:1093214983
Name:WALL-MILES, CHAZIA (LPC)
Entity Type:Individual
Prefix:
First Name:CHAZIA
Middle Name:
Last Name:WALL-MILES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51542 COUSHATTA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-2187
Mailing Address - Country:US
Mailing Address - Phone:803-629-6680
Mailing Address - Fax:
Practice Address - Street 1:14138 HWY 195
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4850
Practice Address - Country:US
Practice Address - Phone:803-629-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional