Provider Demographics
NPI:1558791947
Name:MILLER, CHANDELL (MS, CSAC, SAP)
Entity Type:Individual
Prefix:
First Name:CHANDELL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS, CSAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 MILL RD
Mailing Address - Street 2:100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4677
Mailing Address - Country:US
Mailing Address - Phone:703-224-8929
Mailing Address - Fax:
Practice Address - Street 1:2331 MILL RD
Practice Address - Street 2:100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4677
Practice Address - Country:US
Practice Address - Phone:703-224-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)