Healthcare Provider Details

I. General information

NPI: 1114630134
Provider Name (Legal Business Name): ELENI ANASTASIA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 LOG CANOE CIR
STEVENSVILLE MD
21666-2127
US

IV. Provider business mailing address

113 FAIRVIEW DR
CHESTERTOWN MD
21620-2882
US

V. Phone/Fax

Practice location:
  • Phone: 410-604-0226
  • Fax:
Mailing address:
  • Phone: 443-386-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: