Provider Demographics
NPI:1326214883
Name:MCMILLIAN, KATHRYN N (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:N
Last Name:MCMILLIAN
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 1:2601 KAVANAUGH BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3990
Mailing Address - Country:US
Mailing Address - Phone:501-663-8990
Mailing Address - Fax:
Practice Address - Street 1:2601 KAVANAUGH BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3990
Practice Address - Country:US
Practice Address - Phone:501-663-8990
Practice Address - Fax:501-663-8997
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2236-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A859Medicare PIN