Provider Demographics
NPI:1225450232
Name:MILLER, MIKAH (LPC)
Entity Type:Individual
Prefix:
First Name:MIKAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 SIXES RD STE 2302
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9125
Mailing Address - Country:US
Mailing Address - Phone:770-224-7245
Mailing Address - Fax:470-867-3270
Practice Address - Street 1:3395 SIXES RD STE 2302
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9125
Practice Address - Country:US
Practice Address - Phone:770-224-7245
Practice Address - Fax:470-867-3270
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007813101YP2500X
GALPC007814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183040AMedicaid