Provider Demographics
NPI:1184847816
Name:MILLARD, SOLA GORDHAMER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SOLA
Middle Name:GORDHAMER
Last Name:MILLARD
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 1:1022 S HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6014
Mailing Address - Country:US
Mailing Address - Phone:812-339-5627
Mailing Address - Fax:
Practice Address - Street 1:1022 S HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6014
Practice Address - Country:US
Practice Address - Phone:812-339-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005164A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical