Provider Demographics
NPI:1285454579
Name:MILLER, MATTHEW THURMAN (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:THURMAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4814
Mailing Address - Country:US
Mailing Address - Phone:803-391-9746
Mailing Address - Fax:
Practice Address - Street 1:7300 CARMEL EXECUTIVE PARK DR STE 115
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1310
Practice Address - Country:US
Practice Address - Phone:704-909-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10166106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist