Provider Demographics
NPI:1417245036
Name:MILLAN, LUCIA MARISELA (LCSW)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:MARISELA
Last Name:MILLAN
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 1:2050 MCCLOUD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1609
Mailing Address - Country:US
Mailing Address - Phone:619-993-2964
Mailing Address - Fax:
Practice Address - Street 1:2050 MCCLOUD RIVER RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1609
Practice Address - Country:US
Practice Address - Phone:619-993-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26888104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker