Healthcare Provider Details

I. General information

NPI: 1932652195
Provider Name (Legal Business Name): MILLICENT PARKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2016
Last Update Date: 07/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 AUTRY ST
NORCROSS GA
30071-1919
US

IV. Provider business mailing address

3000 OLD ALABAMA RD SUITE 119-109
JOHNS CREEK GA
30022-5860
US

V. Phone/Fax

Practice location:
  • Phone: 770-464-5123
  • Fax:
Mailing address:
  • Phone: 770-464-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number008548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: