Provider Demographics
NPI:1184486185
Name:MILLIGAN, SUSAN LYNN (LAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 HINSON LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3902
Mailing Address - Country:US
Mailing Address - Phone:501-444-2141
Mailing Address - Fax:
Practice Address - Street 1:11815 HINSON LOOP ROAD
Practice Address - Street 2:SUITE 116
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:014-442-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2112012101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor