Provider Demographics
NPI:1689443632
Name:MILLER, TATIANA RAYSHEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:RAYSHEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CENTENNIAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-0016
Mailing Address - Country:US
Mailing Address - Phone:404-259-4035
Mailing Address - Fax:
Practice Address - Street 1:141 CENTENNIAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-0016
Practice Address - Country:US
Practice Address - Phone:404-259-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0058361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical