MEDICARE: CHRISTINA MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	10122	SC

General Provider Information

NPI Number	:	1457646531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MILLER

Provider Business Mailing Address
First Line	:	56 LEATHERWOOD DR
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-7108
Country	:	US
Telephone Number	:	803-677-5042
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 LEATHERWOOD DR
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-7108
Country	:	US
Telephone Number	:	803-677-5042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	01/19/2026

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