Provider Demographics
NPI:1780460618
Name:MILLER, HAIVON (RPRS)
Entity type:Individual
Prefix:
First Name:HAIVON
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 BERKMAR CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1464
Mailing Address - Country:US
Mailing Address - Phone:434-400-9668
Mailing Address - Fax:434-465-6018
Practice Address - Street 1:2137 LAKESIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6808
Practice Address - Country:US
Practice Address - Phone:434-400-9668
Practice Address - Fax:434-465-6018
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA07350565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)