Provider Demographics
NPI:1225343718
Name:MCMILLIAN, MONICA LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LYNN
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 KANAWHA BLVD E
Mailing Address - Street 2:SUITE 900
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2841
Mailing Address - Country:US
Mailing Address - Phone:304-720-1060
Mailing Address - Fax:304-720-0290
Practice Address - Street 1:1018 KANAWHA BLVD E
Practice Address - Street 2:SUITE 900
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2841
Practice Address - Country:US
Practice Address - Phone:304-720-1060
Practice Address - Fax:304-720-0290
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1000103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily