Provider Demographics
NPI:1629832845
Name:MILLER, HAVILAH (MA)
Entity Type:Individual
Prefix:
First Name:HAVILAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 206
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5821
Mailing Address - Country:US
Mailing Address - Phone:706-969-0420
Mailing Address - Fax:
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 206
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5821
Practice Address - Country:US
Practice Address - Phone:770-892-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC0009497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty