Provider Demographics
NPI:1770851958
Name:MILES, LAWANDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAWANDA
Middle Name:
Last Name:MILES
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 1:8333 OFFICE PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6937
Mailing Address - Country:US
Mailing Address - Phone:678-292-3572
Mailing Address - Fax:
Practice Address - Street 1:4804 SPINEPOINT WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2094
Practice Address - Country:US
Practice Address - Phone:678-292-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional