Individual
JACKIE CHARLENE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
233 12TH ST STE 911-D, COLUMBUS, GA 31901-2462
(706) 566-0805
Mailing address
233 12TH ST STE 911-D, COLUMBUS, GA 31901-2462
(706) 566-0805
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
LPC010997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196506062019
—
GA
Enumeration date
07/23/2020
Last updated
05/03/2023
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