Healthcare Provider Details

I. General information

NPI: 1073448635
Provider Name (Legal Business Name): AMANDA NICOLE MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BRANDIMERE DR
GROVETOWN GA
30813-2808
US

IV. Provider business mailing address

152 BRANDIMERE DR
GROVETOWN GA
30813-2808
US

V. Phone/Fax

Practice location:
  • Phone: 210-870-9731
  • Fax:
Mailing address:
  • Phone: 210-870-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: