Provider Demographics
NPI:1649949157
Name:MILLARD, CHRISTINA WILSON (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:WILSON
Last Name:MILLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 COUNTY ROAD 29
Mailing Address - Street 2:
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085-4614
Mailing Address - Country:US
Mailing Address - Phone:205-351-1887
Mailing Address - Fax:
Practice Address - Street 1:102 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2332
Practice Address - Country:US
Practice Address - Phone:205-287-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional