Provider Demographics
NPI:1023283231
Name:MILLER, CHRISTINE PONCE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:PONCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 PACKARD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2280
Mailing Address - Country:US
Mailing Address - Phone:734-477-9999
Mailing Address - Fax:734-477-0955
Practice Address - Street 1:3840 PACKARD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2280
Practice Address - Country:US
Practice Address - Phone:734-477-9999
Practice Address - Fax:734-477-0955
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health