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General NPI Number Information
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NPI Number | 1083943625
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Entity Type | Organization
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Legal Business Name | KIRSTEN MILLER LLC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 14 EASTBROOK BEND EXECUTIVE CENTER
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City | PEACHTREE CITY
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State | GA
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Zip | 30269
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Country | US
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Telephone | 404-660-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 130 WINDALIER RDG
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3208
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Country | US
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Telephone | 404-660-1118
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | KIRSTEN MILLER
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Credential | L.C.S.W.
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Telephone | 404-660-1118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | CSW004141
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License Number State | GA
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