Provider Demographics
NPI:1982798179
Name:MILLER, COSSANDRA EVETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COSSANDRA
Middle Name:EVETTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S SHARON AMITY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2893
Mailing Address - Country:US
Mailing Address - Phone:704-763-9555
Mailing Address - Fax:704-709-8580
Practice Address - Street 1:233 S SHARON AMITY RD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2893
Practice Address - Country:US
Practice Address - Phone:704-763-9555
Practice Address - Fax:704-709-8580
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005101101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106146Medicaid
NCQ40728A927Medicare UPIN
NC2860065AMedicare UPIN