Provider Demographics
NPI:1649578683
Name:MILLER, PATRICE MARIE (PHD, LCPC, LCADC)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7081
Mailing Address - Country:US
Mailing Address - Phone:301-467-7803
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5213
Practice Address - Country:US
Practice Address - Phone:104-278-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA2435101YA0400X
MDLC2249101YP2500X, 101YP2500X
VA507666101YA0400X
MDNCMHCE 302183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13622206OtherCOUNCIL FOR AFFORDABLE QUALITY HEALTHCARE