Provider Demographics
NPI:1083948897
Name:MACMILLAN, SUSAN DANIELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DANIELLE
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 OLD ALABAMA RD.
Mailing Address - Street 2:S.200 THE SUMMIT COUNSELING CENTER
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:678-893-6300
Mailing Address - Fax:678-893-5312
Practice Address - Street 1:2750 OLD ALABAMA RD.
Practice Address - Street 2:S.200 THE SUMMIT COUNSELING CENTER
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:678-893-6300
Practice Address - Fax:678-893-5312
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0025151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical