Healthcare Provider Details

I. General information

NPI: 1174951966
Provider Name (Legal Business Name): ROSAMELLA MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 TAYLOR CIR
GROVETOWN GA
30813-2222
US

IV. Provider business mailing address

112 TAYLOR CIR
GROVETOWN GA
30813-2222
US

V. Phone/Fax

Practice location:
  • Phone: 706-305-6617
  • Fax:
Mailing address:
  • Phone: 706-305-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007342
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: