Provider Demographics
NPI:1952033342
Name:MCMILLIAN, SHDAVIA ASHA
Entity Type:Individual
Prefix:
First Name:SHDAVIA
Middle Name:ASHA
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:MCMILLIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:710 N WINDOWPANE WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8979
Mailing Address - Country:US
Mailing Address - Phone:864-529-4444
Mailing Address - Fax:
Practice Address - Street 1:306A MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4022
Practice Address - Country:US
Practice Address - Phone:864-315-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health