Provider Demographics
NPI:1649096546
Name:COMSUDES, MARIA MILLER (MS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MILLER
Last Name:COMSUDES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3904
Mailing Address - Country:US
Mailing Address - Phone:404-274-5020
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 622
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7777
Practice Address - Country:US
Practice Address - Phone:678-404-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health