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Organization
TIDWELL& MILLER COUNSELING SERVICES, LLC
Active
Organization
TIDWELL& MILLER COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS WARDRETT MILLER LCSW (MANAGING PARTNER)
(404) 626-9690
Entity
Organization
Contact information
Practice address
215 CHURCH ST STE 105, DECATUR, GA 30030-3330
(404) 626-9690
(770) 808-9273
Mailing address
215 CHURCH ST STE 105, DECATUR, GA 30030-3330
(404) 626-9690
(770) 808-9273
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW000649
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112377A
—
GA
01
—
1053692848
INDIVIDUAL NPI
GA
01
—
1750602173
ORGANIZATIONAL NPI
GA
Enumeration date
12/06/2012
Last updated
12/06/2012
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