Organization
DOMINA UMBRAE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM DAVID MILLER LPC (OWNER)
(706) 442-9127
Entity
Organization
Contact information
Practice address
2155 MEADOR AVE SE, ATLANTA, GA 30315-7407
(706) 442-9127
Mailing address
330 HIGH HARDIN WAY, LAWRENCEVILLE, GA 30043-6091
(706) 442-9127
(732) 753-7415
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC004441
GA
Other
Enumeration date
10/09/2013
Last updated
10/09/2013
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