Healthcare Provider Details

I. General information

NPI: 1427249143
Provider Name (Legal Business Name): THE MILESTONE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 EAGLES WALK STE F
STOCKBRIDGE GA
30281-6342
US

IV. Provider business mailing address

155 EAGLES WALK STE F
STOCKBRIDGE GA
30281-6342
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax: 770-389-3030
Mailing address:
  • Phone: 770-389-8100
  • Fax: 770-389-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number004762
License Number StateGA

VIII. Authorized Official

Name: NANCY GOGINS
Title or Position: OWNER
Credential: LPC
Phone: 770-389-8100