Provider Demographics
NPI:1851160378
Name:CHILDREE, MILLICENT NAOMI
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:NAOMI
Last Name:CHILDREE
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 1:4 BARLEY CT
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-5419
Mailing Address - Country:US
Mailing Address - Phone:707-335-7111
Mailing Address - Fax:
Practice Address - Street 1:4 BARLEY CT
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856-5419
Practice Address - Country:US
Practice Address - Phone:707-335-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician