Provider Demographics
NPI:1285729483
Name:MILLER, REBECCA H (MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:HANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPA BCBA
Mailing Address - Street 1:4929 DARCY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7622
Mailing Address - Country:US
Mailing Address - Phone:919-810-1459
Mailing Address - Fax:919-400-4224
Practice Address - Street 1:4929 DARCY WOODS LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7622
Practice Address - Country:US
Practice Address - Phone:919-810-1459
Practice Address - Fax:919-400-4224
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NC2547103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty