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General NPI Number Information
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NPI Number | 1861272346
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Entity Type | Individual
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Provider Name | COURTNEY MICHELLE MILLER
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Gender | Male
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 17039 OAK ST
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City | DILLWYN
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State | VA
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Zip | 23936-3019
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Country | US
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Telephone | 434-394-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 5944 W JAMES ANDERSON HWY
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City | GLADSTONE
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State | VA
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Zip | 24553-3707
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Country | US
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Telephone | 434-316-8478
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | VA
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