Provider Demographics
NPI:1013462258
Name:MCALILLY, MILLICENT (LCSW)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:
Last Name:MCALILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 S EASON BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6583
Mailing Address - Country:US
Mailing Address - Phone:662-377-6610
Mailing Address - Fax:662-377-6614
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6583
Practice Address - Country:US
Practice Address - Phone:662-377-6610
Practice Address - Fax:662-377-6614
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC67751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical