Healthcare Provider Details

I. General information

NPI: 1992857270
Provider Name (Legal Business Name): TRISHA R MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 UPWARD RD UNIT 1
FLAT ROCK NC
28731-8592
US

IV. Provider business mailing address

580 UPWARD RD UNIT 1
FLAT ROCK NC
28731-8592
US

V. Phone/Fax

Practice location:
  • Phone: 828-696-3531
  • Fax: 828-696-0952
Mailing address:
  • Phone: 828-696-3531
  • Fax: 828-696-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPP2526
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2526
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier015R6
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS OF NC
# 2
Identifier6000144
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier2088658
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerCIGNA BEHAVIORAL HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: