Provider Demographics
NPI:1760686380
Name:MILLER, MELISSA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 S MINT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4629
Mailing Address - Country:US
Mailing Address - Phone:704-644-2852
Mailing Address - Fax:
Practice Address - Street 1:4425 RANDOLPH RD
Practice Address - Street 2:SUITE 411
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2351
Practice Address - Country:US
Practice Address - Phone:704-222-7398
Practice Address - Fax:704-362-1170
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical