Provider Demographics
NPI:1568872406
Name:MILLER, DONNA (LCMHCS, ITFS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCMHCS, ITFS
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 1287
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1287
Mailing Address - Country:US
Mailing Address - Phone:910-672-6766
Mailing Address - Fax:919-882-9599
Practice Address - Street 1:1566 UNION RD STE E2
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5301
Practice Address - Country:US
Practice Address - Phone:910-672-6766
Practice Address - Fax:919-882-9599
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X, 252Y00000X
NC9079A106H00000X
NC10584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency