Provider Demographics
NPI:1225504103
Name:MCMILLAN, REKISHIA LASHON (MSW, CINHC, CMHIMP)
Entity Type:Individual
Prefix:MRS
First Name:REKISHIA
Middle Name:LASHON
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MSW, CINHC, CMHIMP
Other - Prefix:
Other - First Name:REKISHIA
Other - Middle Name:LASHON
Other - Last Name:BEANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CINHC
Mailing Address - Street 1:405 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4125
Mailing Address - Country:US
Mailing Address - Phone:732-966-5809
Mailing Address - Fax:
Practice Address - Street 1:405 DAFFODIL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4125
Practice Address - Country:US
Practice Address - Phone:732-966-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW052771001041C0700X, 101YP1600X, 104100000X, 133NN1002X, 374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner