Provider Demographics
NPI:1295862373
Name:MCMILLAN, VICTORIA DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:DIANE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3241
Mailing Address - Country:US
Mailing Address - Phone:541-912-8347
Mailing Address - Fax:541-345-4419
Practice Address - Street 1:3003 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3241
Practice Address - Country:US
Practice Address - Phone:541-912-8347
Practice Address - Fax:541-345-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR20241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical