Provider Demographics
NPI:1427812460
Name:MILLER, KATHRYN NICOLE (LAC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1513
Mailing Address - Country:US
Mailing Address - Phone:917-992-0839
Mailing Address - Fax:
Practice Address - Street 1:750 ROUTE 73 S STE 210
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4133
Practice Address - Country:US
Practice Address - Phone:856-399-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00754800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor