Provider Demographics
NPI:1942636451
Name:MIRANDA, VALERIE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:MARIE
Last Name:MIRANDA
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 1:1060 GAINES SCHOOL RD STE B3
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6323
Mailing Address - Country:US
Mailing Address - Phone:706-424-0878
Mailing Address - Fax:678-922-7767
Practice Address - Street 1:1060 GAINES SCHOOL RD STE B3
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6323
Practice Address - Country:US
Practice Address - Phone:706-424-0878
Practice Address - Fax:678-922-7767
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002968101YP2500X
GA262029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional