Provider Demographics
NPI:1184980369
Name:SUSAN LW MILLER MS LLC
Entity type:Organization
Organization Name:SUSAN LW MILLER MS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:404-429-3732
Mailing Address - Street 1:135 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4861
Mailing Address - Country:US
Mailing Address - Phone:404-429-3732
Mailing Address - Fax:
Practice Address - Street 1:11815 NORTHFALL LN
Practice Address - Street 2:SUITE 1006
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7973
Practice Address - Country:US
Practice Address - Phone:770-240-8375
Practice Address - Fax:770-442-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty