Provider Demographics
NPI:1164140067
Name:MILLER, TANEA NICOLE
Entity type:Individual
Prefix:
First Name:TANEA
Middle Name:NICOLE
Last Name:MILLER
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 1:10005 OLD COLUMBIA RD STE L260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1722
Mailing Address - Country:US
Mailing Address - Phone:443-259-0400
Mailing Address - Fax:443-259-0044
Practice Address - Street 1:10005 OLD COLUMBIA RD STE L260
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1722
Practice Address - Country:US
Practice Address - Phone:443-259-0400
Practice Address - Fax:443-259-0044
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health