Healthcare Provider Details

I. General information

NPI: 1942126362
Provider Name (Legal Business Name): PAUL JAY MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

PSC 80 BOX 17721
APO AP
96367-0080
US

V. Phone/Fax

Practice location:
  • Phone: 443-569-8882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: