Provider Demographics
NPI:1669008033
Name:MILLER, ABIGAIL DOREEN
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DOREEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GOVERNORS CT APT 2201
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-4322
Mailing Address - Country:US
Mailing Address - Phone:443-207-6504
Mailing Address - Fax:
Practice Address - Street 1:6095 PINE MOUNTAIN RD NW STE 105
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3332
Practice Address - Country:US
Practice Address - Phone:678-217-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty