Provider Demographics
NPI:1154551315
Name:MILLER, ANISA L (MA, CDP)
Entity type:Individual
Prefix:MS
First Name:ANISA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, CDP
Other - Prefix:MS
Other - First Name:ANISA
Other - Middle Name:L
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CDP
Mailing Address - Street 1:5930 SE ARCADIA RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8330
Mailing Address - Country:US
Mailing Address - Phone:360-888-5451
Mailing Address - Fax:360-432-0426
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3574
Practice Address - Country:US
Practice Address - Phone:360-888-5451
Practice Address - Fax:360-432-0426
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00038976101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor