Healthcare Provider Details

I. General information

NPI: 1801212535
Provider Name (Legal Business Name): TERRY MILLER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 LYNDHURST RD
WAYNESBORO VA
22980-9420
US

IV. Provider business mailing address

2645 LYNDHURST RD
WAYNESBORO VA
22980-9420
US

V. Phone/Fax

Practice location:
  • Phone: 540-414-4476
  • Fax: 540-464-3121
Mailing address:
  • Phone: 540-414-4476
  • Fax: 540-464-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: