Provider Demographics
NPI:1811644164
Name:MILLER, CARLISHA S
Entity type:Individual
Prefix:
First Name:CARLISHA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 VAN WYE ST SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5416
Mailing Address - Country:US
Mailing Address - Phone:330-984-7743
Mailing Address - Fax:
Practice Address - Street 1:2875 VAN WYE ST SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5416
Practice Address - Country:US
Practice Address - Phone:330-984-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service