Provider Demographics
NPI:1164899365
Name:MILLHAM, SUSAN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MILLHAM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MILLHAM LICSW PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7000 COOMBS FARM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0803
Mailing Address - Country:US
Mailing Address - Phone:304-435-3494
Mailing Address - Fax:304-205-0105
Practice Address - Street 1:7000 COOMBS FARM RD
Practice Address - Street 2:STE 202
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0803
Practice Address - Country:US
Practice Address - Phone:304-413-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009441941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical