Provider Demographics
NPI:1639761067
Name:MILLER, JAIME MARIE
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
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 1:17039 OAK ST
Mailing Address - Street 2:
Mailing Address - City:DILLWYN
Mailing Address - State:VA
Mailing Address - Zip Code:23936-3019
Mailing Address - Country:US
Mailing Address - Phone:434-941-5476
Mailing Address - Fax:
Practice Address - Street 1:17039 OAK ST
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-3019
Practice Address - Country:US
Practice Address - Phone:434-941-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional