Provider Demographics
NPI:1104138338
Name:MILLER, LAJOSHA SHRELL (LMHC)
Entity type:Individual
Prefix:
First Name:LAJOSHA
Middle Name:SHRELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LAJOSHA
Other - Middle Name:SHRELL
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:6797 GENTLE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3691
Mailing Address - Country:US
Mailing Address - Phone:904-742-9890
Mailing Address - Fax:
Practice Address - Street 1:4570 C ST JOHNA AVE
Practice Address - Street 2:STE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-742-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health