Healthcare Provider Details

I. General information

NPI: 1003490707
Provider Name (Legal Business Name): ELIZABETH MILLINER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 HASTINGS LN
ELIZABETH CITY NC
27909-3324
US

IV. Provider business mailing address

104 SADDLERIDGE DR
SOUTH MILLS NC
27976-9489
US

V. Phone/Fax

Practice location:
  • Phone: 252-621-1366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: