Provider Demographics
NPI:1649001967
Name:DRAKE, MILLARD HOLLINGSWORTH (LCMHCA)
Entity type:Individual
Prefix:
First Name:MILLARD
Middle Name:HOLLINGSWORTH
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 MCCLINTOCK RD APT 401
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5391
Mailing Address - Country:US
Mailing Address - Phone:864-546-0196
Mailing Address - Fax:
Practice Address - Street 1:10706 SIKES PL STE 275
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8015
Practice Address - Country:US
Practice Address - Phone:704-577-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health