Provider Demographics
NPI:1629434782
Name:MILLER, CAROLINE ANNE
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:ANNE
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 1:5935 PLAYA VISTA DR
Mailing Address - Street 2:APT 205
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2130
Mailing Address - Country:US
Mailing Address - Phone:314-283-0706
Mailing Address - Fax:424-338-5744
Practice Address - Street 1:5935 PLAYA VISTA DR
Practice Address - Street 2:APT 205
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2130
Practice Address - Country:US
Practice Address - Phone:314-283-0706
Practice Address - Fax:424-338-5744
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI 1135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional