Provider Demographics
NPI:1982339685
Name:FAW, MILLER
Entity Type:Individual
Prefix:
First Name:MILLER
Middle Name:
Last Name:FAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:FAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 CHASE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-7913
Mailing Address - Country:US
Mailing Address - Phone:336-339-7893
Mailing Address - Fax:
Practice Address - Street 1:MILES ANNAS STUDENT SERVICES BUILDING
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:828-262-3148
Practice Address - Fax:828-262-8452
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health