Latasha Miller, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6278 Issued in NC

Practice address

4389 Indian Trail Fairview Rd
Indian Trail, NC 28079-9639

Phone

(704) 859-2762

Fax

(541) 314-9554

NPI assigned

Mar 5, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Protea Psychological Services LLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
  • NPI 1922766849
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1467910836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 PRINE PL APT 4410",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282136288",
            "telephone_number": "704-668-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4389 INDIAN TRAIL FAIRVIEW RD",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280799639",
            "telephone_number": "704-859-2762",
            "fax_number": "541-314-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "LATASHA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-05",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6278",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "0000000000",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Merriman
• Camden Clarice Messier, FNP-C
• Lisbeth Davila Mijangos, NP
• Mila Therapy Services PLLC
• Millenia Health and Wellness
• Ryan Daniel Miller, BCBA, LBA
• Chad Miltenberger, DPT
• Miracle Houses, Inc.
• Julia Mlynarick
• Mobile Maz, Inc. (Mobile Maz)

• Psychologist in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.