Provider Demographics
NPI:1124804752
Name:MCMILLAN, EDWARD LEIGH IV (LCMHCA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEIGH
Last Name:MCMILLAN
Suffix:IV
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N RICE ST
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3431
Mailing Address - Country:US
Mailing Address - Phone:251-363-3906
Mailing Address - Fax:
Practice Address - Street 1:41 N RICE ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3431
Practice Address - Country:US
Practice Address - Phone:251-363-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health