Provider Demographics
NPI:1508555939
Name:MILLER, KEN D (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 W NEW ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1848
Mailing Address - Country:US
Mailing Address - Phone:770-789-1477
Mailing Address - Fax:
Practice Address - Street 1:70 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1714
Practice Address - Country:US
Practice Address - Phone:770-789-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health