Healthcare Provider Details

I. General information

NPI: 1154074631
Provider Name (Legal Business Name): JESSICA PAIGE MILLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E LEE ST
BEL AIR MD
21014-3528
US

IV. Provider business mailing address

PO BOX 837
FOREST HILL MD
21050-0837
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-5168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC14840
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC14840
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: