Provider Demographics
NPI:1730922295
Name:MCMILLAN, LAKEISHA L
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:L
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 1:15025 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-2318
Mailing Address - Country:US
Mailing Address - Phone:313-623-0472
Mailing Address - Fax:
Practice Address - Street 1:15025 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2318
Practice Address - Country:US
Practice Address - Phone:313-623-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service