MEDICARE: SUSAN LW MILLER MS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	004839	GA

General Provider Information

NPI Number	:	1184980369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN LW MILLER MS LLC

Provider Business Mailing Address
First Line	:	135 RIVER RUN
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-4861
Country	:	US
Telephone Number	:	404-429-3732
Fax Number	:

Provider Business Practice Location Address
First Line	:	11815 NORTHFALL LN
Second Line	:	SUITE 1006
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-7973
Country	:	US
Telephone Number	:	770-240-8375
Fax Number	:	770-442-7774

Authorized Official
Title or Position	:	MANAGER
Name	:	SUSAN LW MILLER
Credential	:	LPC, LMFT
Telephone Number	:	404-429-3732

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	04/02/2012

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