Provider Demographics
NPI:1952762171
Name:MCMILLIAN, MYISHANKA ATARI (LPCA/LCAS)
Entity Type:Individual
Prefix:MS
First Name:MYISHANKA
Middle Name:ATARI
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:LPCA/LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLIVENE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6755
Mailing Address - Country:US
Mailing Address - Phone:919-724-9733
Mailing Address - Fax:919-864-9629
Practice Address - Street 1:3 OLIVENE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6755
Practice Address - Country:US
Practice Address - Phone:919-724-9733
Practice Address - Fax:919-864-9629
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCA12220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)