Provider Demographics
NPI:1720593072
Name:MILES, CHERAE (LIFE COACH CERTIFICA)
Entity Type:Individual
Prefix:
First Name:CHERAE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LIFE COACH CERTIFICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 BUNKER HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2804
Mailing Address - Country:US
Mailing Address - Phone:904-476-5412
Mailing Address - Fax:
Practice Address - Street 1:862 BUNKER HILL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3220
Practice Address - Country:US
Practice Address - Phone:904-476-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional