Provider Demographics
NPI:1942361746
Name:MILES, CHRISTY VITOU (MA, LCMHC, NBCC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:VITOU
Last Name:MILES
Suffix:
Gender:F
Credentials:MA, LCMHC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8259
Mailing Address - Country:US
Mailing Address - Phone:336-250-3130
Mailing Address - Fax:
Practice Address - Street 1:119 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-8259
Practice Address - Country:US
Practice Address - Phone:336-250-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-05-09
Deactivation Date:2017-12-14
Deactivation Code:
Reactivation Date:2021-06-22
Provider Licenses
StateLicense IDTaxonomies
NC4791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional