Provider Demographics
NPI:1861272346
Name:MILLER, COURTNEY MICHELLE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 W JAMES ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:24553-3707
Mailing Address - Country:US
Mailing Address - Phone:434-316-8478
Mailing Address - Fax:
Practice Address - Street 1:17039 OAK ST
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936-3019
Practice Address - Country:US
Practice Address - Phone:434-394-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician