Individual
MARK MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3605 CALUMET ST, PHILADELPHIA, PA 19129-1603
(267) 879-2152
Mailing address
3605 CALUMET ST, PHILADELPHIA, PA 19129-1603
(267) 879-2152
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PC003947
PA
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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