Provider Demographics
NPI:1972848976
Name:HOWARD, MILDRED (PHD, LPC)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 HIGHLANDS PKWY SE
Mailing Address - Street 2:STE G
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5176
Mailing Address - Country:US
Mailing Address - Phone:678-838-8333
Mailing Address - Fax:678-838-8444
Practice Address - Street 1:3827 ROSWELL RD STE 100B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6297
Practice Address - Country:US
Practice Address - Phone:404-514-9283
Practice Address - Fax:844-584-5352
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YS0200X, 103TS0200X
GALPC004112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool