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General NPI Number Information
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NPI Number | 1629533161
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Entity Type | Individual
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Provider Name | CARRIE MILLER
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 4343 SHALLOWFORD RD STE 4
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City | MARIETTA
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State | GA
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Zip | 30062-5023
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Country | US
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Telephone | 678-694-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 702 PINE BLUFF CT
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City | WOODSTOCK
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State | GA
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Zip | 30189-7044
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Country | US
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Telephone | 260-417-5262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC006847
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License Number State | GA
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