Individual
JERRY L. MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
930 CAMBRIDGE ST STE 107, FAYETTEVILLE, NC 28303-5356
(910) 433-2307
Mailing address
930 CAMBRIDGE ST STE 107, FAYETTEVILLE, NC 28303-5356
(910) 433-2307
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
945
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6107454
—
NC
Enumeration date
03/27/2007
Last updated
07/08/2007
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