Provider Demographics
NPI:1700204351
Name:MCMILLIAN, IVORY MELANIE (PSYD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:IVORY
Middle Name:MELANIE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:PSYD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 2ND ST NE
Mailing Address - Street 2:LL-12
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3557
Mailing Address - Country:US
Mailing Address - Phone:202-832-2950
Mailing Address - Fax:202-832-2951
Practice Address - Street 1:900 2ND ST NE
Practice Address - Street 2:LL-12
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3557
Practice Address - Country:US
Practice Address - Phone:202-832-2950
Practice Address - Fax:202-832-2951
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY200001474103TC0700X
DCPRC13802101YP2500X
VA0810007440103TC0700X
VA0701005585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical