Provider Demographics
NPI:1922390087
Name:MILLER, CARRIE ANN (LMSW, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PAULINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5228
Mailing Address - Country:US
Mailing Address - Phone:734-474-2964
Mailing Address - Fax:734-780-7132
Practice Address - Street 1:1525 PAULINE BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5228
Practice Address - Country:US
Practice Address - Phone:734-474-2964
Practice Address - Fax:734-780-7132
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-07-3878103K00000X
MI68010895291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical