Provider Demographics
NPI:1184820045
Name:MCMILLAN, CARLOS NICKDILOUS
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:NICKDILOUS
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 JAMAICA DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5487
Mailing Address - Country:US
Mailing Address - Phone:843-382-5308
Mailing Address - Fax:
Practice Address - Street 1:1399 HARMONY CAMP RD
Practice Address - Street 2:
Practice Address - City:GREELEYVILLE
Practice Address - State:SC
Practice Address - Zip Code:29056-9666
Practice Address - Country:US
Practice Address - Phone:803-473-4656
Practice Address - Fax:803-473-4676
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor