Provider Demographics
NPI:1851059042
Name:MILLER, AMY GAYLE (MS, CASAC, LCAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GAYLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CASAC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 OLDE REGENT WAY STE 150-270
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4193
Mailing Address - Country:US
Mailing Address - Phone:585-748-1141
Mailing Address - Fax:
Practice Address - Street 1:5050 TRADEWAY DR APT 408
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4291
Practice Address - Country:US
Practice Address - Phone:585-748-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31117101YA0400X
NY002479221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)