Provider Demographics
NPI:1659147783
Name:MCMILLAN, ADAIRE FREIDA (CDCA)
Entity Type:Individual
Prefix:
First Name:ADAIRE
Middle Name:FREIDA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7773 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:CAMP DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:45111-9703
Mailing Address - Country:US
Mailing Address - Phone:619-261-1184
Mailing Address - Fax:
Practice Address - Street 1:25 WHITNEY DR STE 120
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8400
Practice Address - Country:US
Practice Address - Phone:513-659-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)