Provider Demographics
NPI:1013779982
Name:MILLER, GEANNA LYNETTE (LMSW)
Entity Type:Individual
Prefix:
First Name:GEANNA
Middle Name:LYNETTE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BENTLEY RD SE APT 808
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3204
Mailing Address - Country:US
Mailing Address - Phone:404-435-5037
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE APT 228
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1980
Practice Address - Country:US
Practice Address - Phone:404-435-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW011145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker