Provider Demographics
NPI:1639445620
Name:MILLER, KRISTAL (LCADC, LPC)
Entity type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07061-0348
Mailing Address - Country:US
Mailing Address - Phone:908-472-4411
Mailing Address - Fax:
Practice Address - Street 1:1446 BRENTWOOD TER
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3302
Practice Address - Country:US
Practice Address - Phone:908-472-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00070000101YA0400X
PAPC012672101YP2500X
DEPC0011276101YP2500X
NJ37PC00464300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)