Provider Demographics
NPI:1336705201
Name:MCMILLAN, JACQUELINE (LPCA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7020
Mailing Address - Country:US
Mailing Address - Phone:910-483-5986
Mailing Address - Fax:910-483-2876
Practice Address - Street 1:705 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7020
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:910-483-2876
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional