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General NPI Number Information
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NPI Number | 1467910836
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Entity Type | Individual
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Provider Name | LATASHA MILLER PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 4389 INDIAN TRAIL FAIRVIEW RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-9639
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Country | US
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Telephone | 704-859-2762
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Fax | 541-314-9554
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Provider Business Mailing Address
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Address Line | 335 PRINE PL APT 4410
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City | CHARLOTTE
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State | NC
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Zip | 28213-6288
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Country | US
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Telephone | 704-668-6635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6278
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0000000000
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License Number State | OR
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