Provider Demographics
NPI:1952639817
Name:MCMILLIAN, ELLEN LESTINE (MSW PLCSW CSAC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LESTINE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MSW PLCSW CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2127
Mailing Address - Country:US
Mailing Address - Phone:910-806-5565
Mailing Address - Fax:
Practice Address - Street 1:103 MCCABE STREET
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364
Practice Address - Country:US
Practice Address - Phone:910-844-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO157381041C0700X
RICSW035141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical