Provider Demographics
NPI:1386218774
Name:MCMILLAN, MARIAH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MCMILLAN
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 1:69 SUGARCAMP LN
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-2916
Mailing Address - Country:US
Mailing Address - Phone:540-560-9520
Mailing Address - Fax:
Practice Address - Street 1:25 NORTHRIDGE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3399
Practice Address - Country:US
Practice Address - Phone:540-464-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040128821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical