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General NPI Number Information
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NPI Number | 1629614789
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Entity Type | Individual
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Provider Name | GENNA MILLER MA, LCAS-R
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 7540 RAMBLE WAY STE 109
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City | RALEIGH
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State | NC
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Zip | 27616-4318
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Country | US
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Telephone | 252-281-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 4704 COUNTRY CLUB DR N
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City | WILSON
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State | NC
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Zip | 27896-9116
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Country | US
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Telephone | 315-256-3378
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-25948
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A16834
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License Number State | NC
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