Provider Demographics
NPI:1134251481
Name:MILLER, BRENDA JOYCE (MS, CATC, CATE)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CATC, CATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9465 FARNHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1308
Mailing Address - Country:US
Mailing Address - Phone:858-573-2600
Mailing Address - Fax:858-573-5144
Practice Address - Street 1:9465 FARNHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1308
Practice Address - Country:US
Practice Address - Phone:858-573-2600
Practice Address - Fax:858-573-5144
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0401001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)