Individual
EVAN MILLER THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
108 E PONCE DE LEON AVE STE 204, DECATUR, GA 30030-2512
(510) 566-2367
Mailing address
25857 FOOTHILLS DR N, GOLDEN, CO 80401-8556
(510) 566-2367
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
D6540235
CA
103T00000X
Psychologist
Primary
PSY003899
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11415
SFGH INTERNAL USE ONLY
—
Enumeration date
03/28/2007
Last updated
03/17/2018
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