Provider Demographics
NPI:1194230698
Name:MILLARD, LINDSAY MAE (LISW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MAE
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5878 FAIRCREST ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-3472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1513
Practice Address - Country:US
Practice Address - Phone:330-807-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker