Provider Demographics
NPI:1942845573
Name:MCMILLAN, JALEESA (LPC)
Entity Type:Individual
Prefix:
First Name:JALEESA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-8407
Mailing Address - Country:US
Mailing Address - Phone:334-655-4522
Mailing Address - Fax:334-460-0899
Practice Address - Street 1:2330 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3250
Practice Address - Country:US
Practice Address - Phone:334-655-4522
Practice Address - Fax:334-460-0899
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional