Healthcare Provider Details

I. General information

NPI: 1942636451
Provider Name (Legal Business Name): VALERIE MARIE MIRANDA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAINES SCHOOL RD STE B3
ATHENS GA
30605-6323
US

IV. Provider business mailing address

1060 GAINES SCHOOL RD STE B3
ATHENS GA
30605-6323
US

V. Phone/Fax

Practice location:
  • Phone: 706-424-0878
  • Fax: 678-922-7767
Mailing address:
  • Phone: 706-424-0878
  • Fax: 678-922-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002968
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number262029
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: