MEDICARE: WITH A CHILD'S HEART, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700320983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITH A CHILD'S HEART, LLC.

Provider Business Mailing Address
First Line	:	3395 SIXES RD STE 2302
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9125
Country	:	US
Telephone Number	:	770-224-7245
Fax Number	:

Provider Business Practice Location Address
First Line	:	3395 SIXES RD STE 2302
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-9125
Country	:	US
Telephone Number	:	770-224-7245
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/THERAPIST
Name	:	MIKAH ALEXIS MILLER
Credential	:	LPC
Telephone Number	:	770-224-7245

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	09/11/2023

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