Provider Demographics
NPI:1841047354
Name:MILLER, CARON LYNN (MA)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-9545
Mailing Address - Country:US
Mailing Address - Phone:304-575-2424
Mailing Address - Fax:
Practice Address - Street 1:221 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2609
Practice Address - Country:US
Practice Address - Phone:681-238-6634
Practice Address - Fax:681-238-6638
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor