Provider Demographics
NPI:1245077171
Name:MILLER, ALISSA LEAH (AS)
Entity type:Individual
Prefix:MISS
First Name:ALISSA
Middle Name:LEAH
Last Name:MILLER
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27551 TIM WAGNON LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8650
Mailing Address - Country:US
Mailing Address - Phone:256-777-1934
Mailing Address - Fax:
Practice Address - Street 1:2117 METRO CIR SW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5343
Practice Address - Country:US
Practice Address - Phone:256-701-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1076055106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician