Provider Demographics
NPI:1013642529
Name:MCMILLIAN, EDWARD (ALC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 AIRPORT BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1987
Mailing Address - Country:US
Mailing Address - Phone:251-414-3599
Mailing Address - Fax:251-217-4624
Practice Address - Street 1:3929 AIRPORT BLVD STE 310
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1987
Practice Address - Country:US
Practice Address - Phone:251-414-3599
Practice Address - Fax:251-217-4624
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3290A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty