Provider Demographics
NPI:1255572525
Name:CSCLDL, PC
Entity type:Organization
Organization Name:CSCLDL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:MCMILLON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-322-1479
Mailing Address - Street 1:4323 DOMINIQUE ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2854
Mailing Address - Country:US
Mailing Address - Phone:910-322-1479
Mailing Address - Fax:910-339-2481
Practice Address - Street 1:2014 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4225
Practice Address - Country:US
Practice Address - Phone:910-425-6136
Practice Address - Fax:910-424-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty