MEDICARE: MRS. KIMBERLY D MILLER LPC

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	101YP2500X	Professional Counselor	LPC005128	GA
2	101YP2500X	Professional Counselor	3901	NC
3	101YM0800X	Mental Health Counselor	3901	NC

General Provider Information

NPI Number	:	1811216260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY D MILLER LPC

Provider Business Mailing Address
First Line	:	503 CLINTON DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-5161
Country	:	US
Telephone Number	:	704-810-0515
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 CLINTON DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-5161
Country	:	US
Telephone Number	:	704-810-0515
Fax Number	:

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

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	03/27/2026

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