Provider Demographics
NPI:1952844748
Name:MCMILLIAN, SUSAN (MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14974 WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1624
Mailing Address - Country:US
Mailing Address - Phone:318-512-2185
Mailing Address - Fax:
Practice Address - Street 1:14974 WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1624
Practice Address - Country:US
Practice Address - Phone:318-512-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional