Provider Demographics
NPI:1497542666
Name:PEDERSEN, MILLICENT J
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:J
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 GEORGIA AVE SE STE 206
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3000
Mailing Address - Country:US
Mailing Address - Phone:404-653-0374
Mailing Address - Fax:404-653-0375
Practice Address - Street 1:250 GEORGIA AVE SE STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3000
Practice Address - Country:US
Practice Address - Phone:404-653-0374
Practice Address - Fax:404-653-0375
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health