Provider Demographics
NPI:1467910836
Name:MILLER, LATASHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LATASHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 PRINE PL APT 4410
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6288
Mailing Address - Country:US
Mailing Address - Phone:704-668-6635
Mailing Address - Fax:
Practice Address - Street 1:4389 INDIAN TRAIL FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9639
Practice Address - Country:US
Practice Address - Phone:704-859-2762
Practice Address - Fax:541-314-9554
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6278103T00000X
OR0000000000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical