Provider Demographics
NPI:1902445463
Name:MILLER, EVAN (LCAS-A, LPC-A)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCAS-A, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 DARBLAY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-1002
Mailing Address - Country:US
Mailing Address - Phone:704-253-3045
Mailing Address - Fax:
Practice Address - Street 1:7432 DARBLAY ST
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-1002
Practice Address - Country:US
Practice Address - Phone:704-253-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS24933101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)