Provider Demographics
NPI:1982927570
Name:MILLER, ROBERTA LEE (MAC, SAP, CADC III)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MAC, SAP, CADC III
Other - Prefix:
Other - First Name:ROBBIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC, SAP, CADC III
Mailing Address - Street 1:PO BOX 10924
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296
Mailing Address - Country:US
Mailing Address - Phone:503-816-0345
Mailing Address - Fax:503-293-6188
Practice Address - Street 1:811 NW 20TH AVE
Practice Address - Street 2:SUITE 103C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-816-0345
Practice Address - Fax:503-293-6188
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
507104101YA0400X
WACP00005706101YA0400X
OR05-11-98101YA0400X
101YA0400X
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)