Provider Demographics
NPI:1346929148
Name:MILLER, KERRI LEE (MS, MDIV, LCMHC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, MDIV, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 TOWER RD APT D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5709
Mailing Address - Country:US
Mailing Address - Phone:336-209-1476
Mailing Address - Fax:
Practice Address - Street 1:2150 NC HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-9609
Practice Address - Country:US
Practice Address - Phone:336-520-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6805101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor