Provider Demographics
NPI:1518100668
Name:MILLER, JEANNE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8115
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-8115
Mailing Address - Country:US
Mailing Address - Phone:703-795-7929
Mailing Address - Fax:
Practice Address - Street 1:4402 BLYTH PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4017
Practice Address - Country:US
Practice Address - Phone:831-737-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-18
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004945103T00000X, 103T00000X
VA0701005416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health