Provider Demographics
NPI:1447562350
Name:MILHAM, ANITA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:MILHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4131
Mailing Address - Country:US
Mailing Address - Phone:401-728-1800
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:STE 210
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4131
Practice Address - Country:US
Practice Address - Phone:401-728-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00614251S00000X
MA8251251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health