Healthcare Provider Details

I. General information

NPI: 1548175177
Provider Name (Legal Business Name): SARAH FAIRFAX MILES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 REGENCY PL STE 203
WHITE PLAINS MD
20695-3088
US

IV. Provider business mailing address

23250 CHESTNUT OAK CT APT 1030
CALIFORNIA MD
20619-6043
US

V. Phone/Fax

Practice location:
  • Phone: 240-427-3554
  • Fax:
Mailing address:
  • Phone: 240-640-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16825
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: