Healthcare Provider Details

I. General information

NPI: 1083943625
Provider Name (Legal Business Name): KIRSTEN MILLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 EASTBROOK BEND EXECUTIVE CENTER
PEACHTREE CITY GA
30269
US

IV. Provider business mailing address

130 WINDALIER RDG
PEACHTREE CITY GA
30269-3208
US

V. Phone/Fax

Practice location:
  • Phone: 404-660-1118
  • Fax:
Mailing address:
  • Phone: 404-660-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCSW004141
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: KIRSTEN MILLER
Title or Position: PSYCHOTHERAPIST
Credential: L.C.S.W.
Phone: 404-660-1118