Provider Demographics
NPI:1376216168
Name:MILOM, NATALIE (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MILOM
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 1:26 CHERRYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2380
Mailing Address - Country:US
Mailing Address - Phone:864-561-3298
Mailing Address - Fax:
Practice Address - Street 1:2070 BUFORD HWY STE 1B
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6097
Practice Address - Country:US
Practice Address - Phone:678-829-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0076841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical