Provider Demographics
NPI:1831282326
Name:MILLER, WILLIAM DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAVID
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HIGH HARDIN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6091
Mailing Address - Country:US
Mailing Address - Phone:706-442-9127
Mailing Address - Fax:770-419-1507
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:BLDG B SUITE A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:706-442-9127
Practice Address - Fax:678-921-0354
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC004441OtherLPC LICENSURE NUMBER