Provider Demographics
NPI:1619283736
Name:MCMILLAN, LYNETTE ANDREA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:ANDREA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYNETTE
Other - Middle Name:ANDREA
Other - Last Name:MCMILLAN-MCNAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2105 HUTCHINS CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5149
Mailing Address - Country:US
Mailing Address - Phone:910-257-9517
Mailing Address - Fax:
Practice Address - Street 1:2105 HUTCHINS CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5149
Practice Address - Country:US
Practice Address - Phone:910-257-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NCC0096361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker