Provider Demographics
NPI:1184052599
Name:MILLER, KRISTI LYNN (MAEDS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAEDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E DIXON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6893
Mailing Address - Country:US
Mailing Address - Phone:704-487-4000
Mailing Address - Fax:704-487-4005
Practice Address - Street 1:2505 COURT DRIVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052
Practice Address - Country:US
Practice Address - Phone:704-487-4000
Practice Address - Fax:704-487-4005
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10488101YM0800X
NC10488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health