Provider Demographics
NPI:1699221390
Name:MCMILLAN, SHERRILL
Entity Type:Individual
Prefix:
First Name:SHERRILL
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 LANOVER STREET
Mailing Address - Street 2:APT 1706
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305
Mailing Address - Country:US
Mailing Address - Phone:202-368-2913
Mailing Address - Fax:
Practice Address - Street 1:3201 LANOVER STREET
Practice Address - Street 2:APT 1706
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-1938
Practice Address - Country:US
Practice Address - Phone:202-368-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC80101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional