Provider Information for 1407273816
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SUSAN NECOLE STURDIVANT MILES LPC,NCC
Sex: Female
NPI: 1407273816
Last Updated: 2024-02-12
Certification Date: 2024-02-12
Certification Date: 2024-02-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1407273816 | ||||||||||||
| Enumeration Date | 2014-03-24 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5176 MAINSTREET PARK DR STONE MOUNTAIN, GA 30088-2440 United States Phone: 706-587-9955 | Fax: | ||||||||||||
| Primary Practice Address | 5176 MAINSTREET PARK DR STONE MOUNTAIN, GA 30088-2440 United States Phone: 706-587-9955 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 307 LEE RD 441 | ||||||||||||
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