Provider Demographics
NPI:1972364008
Name:MILLER, DANA PATRICE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:PATRICE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 ALFORD CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3143
Mailing Address - Country:US
Mailing Address - Phone:203-676-2309
Mailing Address - Fax:
Practice Address - Street 1:1008 ALFORD CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3143
Practice Address - Country:US
Practice Address - Phone:203-676-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMFT002092OtherGA STATE BOARD OF PROFESSIONAL LICENSING