Provider Demographics
NPI:1629091673
Name:MILLER, SALLY BICKNELL (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:BICKNELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
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 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:1316 PATTON AVE
Practice Address - Street 2:D
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2666
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:828-225-3604
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13784OtherNVML BCBSNC GRP 015HF
NC6102109Medicaid