Provider Demographics
NPI:1609817402
Name:MACMILLAN, PAMELA (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1844
Mailing Address - Country:US
Mailing Address - Phone:804-342-4300
Mailing Address - Fax:804-342-4316
Practice Address - Street 1:8254 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-342-4300
Practice Address - Fax:804-342-4316
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002924101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA284469OtherANTHEM
VA375677OtherMAMSI
VA2030934OtherCIGNA
VA266920OtherVALUE OPTIONS
VA084940OtherSENTARA BEHAVIORAL
VA7933082OtherAETNA
VA191723OtherCOMPSYCH