Provider Demographics
NPI:1609403849
Name:MILLER, SHAJAVA SHEVOUGNE (CAC-II)
Entity Type:Individual
Prefix:
First Name:SHAJAVA
Middle Name:SHEVOUGNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 2ND ST NW STE 2NORTH
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2003
Mailing Address - Country:US
Mailing Address - Phone:202-783-7343
Mailing Address - Fax:
Practice Address - Street 1:425 2ND ST NW STE 2NORTH
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2003
Practice Address - Country:US
Practice Address - Phone:202-783-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1278101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty