Healthcare Provider Details

I. General information

NPI: 1972848976
Provider Name (Legal Business Name): MILDRED HOWARD PH.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2012
Last Update Date: 03/19/2022
Certification Date: 03/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3827 ROSWELL RD STE 100B
MARIETTA GA
30062-6297
US

IV. Provider business mailing address

3040 HIGHLANDS PKWY SE STE G
SMYRNA GA
30082-5176
US

V. Phone/Fax

Practice location:
  • Phone: 404-514-9283
  • Fax: 844-584-5352
Mailing address:
  • Phone: 678-838-8333
  • Fax: 678-838-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004112
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: