Provider Demographics
NPI:1780426072
Name:MILES, ANGELA ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ANN
Last Name:MILES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANGIE
Other - Middle Name:ANN
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4414 BLACK STALLION DR NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3166
Mailing Address - Country:US
Mailing Address - Phone:770-543-9032
Mailing Address - Fax:
Practice Address - Street 1:11285 ELKINS RD STE D2
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5835
Practice Address - Country:US
Practice Address - Phone:770-790-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional