Provider Demographics
NPI:1912207283
Name:MCMILLAN, SONYA L (LCPC, LCADC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 TOWN CENTER CIR APT 311
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4771
Mailing Address - Country:US
Mailing Address - Phone:301-509-7294
Mailing Address - Fax:
Practice Address - Street 1:8921 TOWN CENTER CIR APT 311
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4771
Practice Address - Country:US
Practice Address - Phone:301-509-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1670101YA0400X
MDLC2545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)