Provider Demographics
NPI:1871807628
Name:MILLER, MARKESHA (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:MARKESHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 PACES RUN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7984
Mailing Address - Country:US
Mailing Address - Phone:803-767-8003
Mailing Address - Fax:
Practice Address - Street 1:3440 TORINGDON WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3190
Practice Address - Country:US
Practice Address - Phone:704-927-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional