Healthcare Provider Details

I. General information

NPI: 1386085074
Provider Name (Legal Business Name): CHARITY ANGELICA MILLER M.S. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 BROCKTON AVE STE A
RIVERSIDE CA
92501-3400
US

IV. Provider business mailing address

27692 CALLANDER ST
MORENO VALLEY CA
92555-5902
US

V. Phone/Fax

Practice location:
  • Phone: 951-888-1346
  • Fax:
Mailing address:
  • Phone: 951-616-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80440
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: