Healthcare Provider Details

I. General information

NPI: 1558063800
Provider Name (Legal Business Name): AMANDA ROBYN MILLER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1763
US

IV. Provider business mailing address

902 GRIER ST APT 116
WOODSTOCK GA
30189-3489
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-2194
  • Fax: 678-922-7767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009365
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015864
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: