Provider Demographics
NPI:1912271396
Name:MILLER, TISHA GAIL (LCSW)
Entity type:Individual
Prefix:MS
First Name:TISHA
Middle Name:GAIL
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 14246
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0143
Mailing Address - Country:US
Mailing Address - Phone:490637-147-6952
Mailing Address - Fax:
Practice Address - Street 1:PSC 2 BOX 14246
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-0143
Practice Address - Country:US
Practice Address - Phone:490637-147-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015199101YM0800X
NJ44SC05296800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health