Provider Demographics
NPI:1891750410
Name:MILLINGTON, JUDY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:B
Last Name:MILLINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:B
Other - Last Name:MILLINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4212
Mailing Address - Country:US
Mailing Address - Phone:423-288-6120
Mailing Address - Fax:423-288-3481
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4212
Practice Address - Country:US
Practice Address - Phone:423-288-6120
Practice Address - Fax:423-288-3481
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN252553000OtherMAGELLAN
TN1510671Medicaid
VA010090407Medicaid
TN2500174OtherBCBS TN
VA010090407Medicaid
VA010090407Medicaid