Provider Demographics
NPI:1396163622
Name:MILLNER, VERA
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:MILLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 TRUMPET CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6329
Mailing Address - Country:US
Mailing Address - Phone:704-536-6853
Mailing Address - Fax:704-536-6045
Practice Address - Street 1:2629 TRUMPET CT
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6329
Practice Address - Country:US
Practice Address - Phone:704-536-6853
Practice Address - Fax:704-536-6045
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2720OtherNCSAPPB