Provider Demographics
NPI:1548489073
Name:MILLER, CHRISTINA BROUGHTON (LCPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:BROUGHTON
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14801 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5613
Mailing Address - Country:US
Mailing Address - Phone:240-994-1320
Mailing Address - Fax:
Practice Address - Street 1:14801 HARVEST LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5613
Practice Address - Country:US
Practice Address - Phone:240-994-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003392800Medicaid