Provider Demographics
NPI:1922200815
Name:MILLER, VICKIE C (LPCLMFT,LAC)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPCLMFT,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2453
Mailing Address - Country:US
Mailing Address - Phone:318-347-2221
Mailing Address - Fax:318-861-2162
Practice Address - Street 1:3018 OLD MINDEN RD STE 1205
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2446
Practice Address - Country:US
Practice Address - Phone:318-746-5636
Practice Address - Fax:318-746-5636
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18524101Y00000X
LA2642101Y00000X
LA304106H00000X
LA974101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist