Provider Demographics
NPI:1114198785
Name:MILLER, VIRGINA (MA, MED, LMHC)
Entity Type:Individual
Prefix:
First Name:VIRGINA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MED, LMHC
Mailing Address - Street 1:1711 12TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2435
Mailing Address - Country:US
Mailing Address - Phone:206-860-1020
Mailing Address - Fax:
Practice Address - Street 1:1711 12TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2435
Practice Address - Country:US
Practice Address - Phone:206-860-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health