Provider Demographics
NPI:1740626415
Name:MILLER, JENNIFER SHERMAN (MED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHERMAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5133
Mailing Address - Country:US
Mailing Address - Phone:704-307-3722
Mailing Address - Fax:
Practice Address - Street 1:2430 REYNOLDA RD
Practice Address - Street 2:B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4626
Practice Address - Country:US
Practice Address - Phone:704-307-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health