Healthcare Provider Details

I. General information

NPI: 1093401010
Provider Name (Legal Business Name): JAKIRA TANAE MILLER LCMHC, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 STONEBURG CT
GREENSBORO NC
27409-8838
US

IV. Provider business mailing address

3209 STONEBURG CT
GREENSBORO NC
27409-8838
US

V. Phone/Fax

Practice location:
  • Phone: 252-327-2728
  • Fax:
Mailing address:
  • Phone: 252-327-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number28641
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016678
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20503
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: