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General NPI Number Information
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NPI Number | 1871246504
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Entity Type | Individual
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Provider Name | ALISHA LYNN MILLER-KHALIAL SUDCC
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Gender |
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1133 COLOMA WAY
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City | ROSEVILLE
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State | CA
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Zip | 95661-4480
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Country | US
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Telephone | 916-774-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 N CIRBY WAY
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City | ROSEVILLE
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State | CA
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Zip | 95661-5609
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Country | US
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Telephone | 916-868-5130
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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 | 12670
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License Number State | CA
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