Provider Demographics
NPI:1629088067
Name:MACMILLAN, JOAN MARIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7803 MADISON AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:CITRUS HTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7695
Mailing Address - Country:US
Mailing Address - Phone:916-967-0991
Mailing Address - Fax:916-967-4080
Practice Address - Street 1:7803 MADISON AVE STE 702
Practice Address - Street 2:
Practice Address - City:CITRUS HTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7695
Practice Address - Country:US
Practice Address - Phone:916-967-0991
Practice Address - Fax:916-967-4080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMHN ID 067243OtherPROVIDER MHN ID #