Healthcare Provider Details

I. General information

NPI: 1548378383
Provider Name (Legal Business Name): GENE S MILLER LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HERITAGE WAY NE STE 302
LEESBURG VA
20176-4544
US

IV. Provider business mailing address

102 HERITAGE WAY NE STE 302
LEESBURG VA
20176-4544
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-5100
  • Fax: 703-777-0170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002291
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: