Provider Demographics
NPI:1922205962
Name:MILLER, MARSHA THOMAS (LPC)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:THOMAS
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:456 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9575
Mailing Address - Country:US
Mailing Address - Phone:601-853-7851
Mailing Address - Fax:601-605-4085
Practice Address - Street 1:199 CHARMANT DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-605-4084
Practice Address - Fax:601-605-4085
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional