Provider Demographics
NPI:1508560640
Name:MILLER, SABRINA TRAVAE (CIT #5363)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:TRAVAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CIT #5363
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LEGION DR
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2764
Mailing Address - Country:US
Mailing Address - Phone:318-605-9186
Mailing Address - Fax:
Practice Address - Street 1:210 LAUREL ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4662
Practice Address - Country:US
Practice Address - Phone:318-619-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)