Provider Demographics
NPI:1578052502
Name:MILLER, CATHERINE MC KENZIE
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MC KENZIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 DAVID TAYLOR DR STE 120-101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1293
Mailing Address - Country:US
Mailing Address - Phone:877-262-2221
Mailing Address - Fax:
Practice Address - Street 1:10926 DAVID TAYLOR DR STE 120-101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1293
Practice Address - Country:US
Practice Address - Phone:877-262-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician