Provider Demographics
NPI:1104009901
Name:MILLER, LEEANNA MARIE
Entity Type:Individual
Prefix:MS
First Name:LEEANNA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEEANNA
Other - Middle Name:MARIE
Other - Last Name:CASTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12125 SHALE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8880
Mailing Address - Country:US
Mailing Address - Phone:530-885-1917
Mailing Address - Fax:
Practice Address - Street 1:12125 SHALE RIDGE LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8880
Practice Address - Country:US
Practice Address - Phone:530-885-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1397900720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)