Provider Demographics
NPI:1821266859
Name:MCMILLAN, TOMHA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:TOMHA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-0101
Mailing Address - Country:US
Mailing Address - Phone:252-412-6613
Mailing Address - Fax:
Practice Address - Street 1:2403 CHIPPENHAM COURT
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590
Practice Address - Country:US
Practice Address - Phone:252-412-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105223Medicaid