Provider Demographics
NPI:1326384611
Name:MCMILLON, KATRINA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MCMILLON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3082
Mailing Address - Country:US
Mailing Address - Phone:202-600-2853
Mailing Address - Fax:
Practice Address - Street 1:1517 30TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3082
Practice Address - Country:US
Practice Address - Phone:202-600-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-12-12143103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst