Provider Demographics
NPI:1467177170
Name:MCMILLON-BROWN, SHAWNTA (CSAC, LPC)
Entity Type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:
Last Name:MCMILLON-BROWN
Suffix:
Gender:F
Credentials:CSAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MICHAEL SELBY DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5037
Mailing Address - Country:US
Mailing Address - Phone:516-242-7739
Mailing Address - Fax:
Practice Address - Street 1:522 S INDEPENDENCE BLVD STE 102D
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1149
Practice Address - Country:US
Practice Address - Phone:757-497-8702
Practice Address - Fax:757-497-8736
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012759101YP2500X
VA0710103068101YA0400X
VA0733006362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)