Provider Demographics
NPI:1215277926
Name:MCMILLIAN, SHAWNTA (LPC)
Entity type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:
Last Name:MCMILLIAN
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 1:3227 PLEASANT GARDEN RD
Mailing Address - Street 2:2C
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4620
Mailing Address - Country:US
Mailing Address - Phone:330-554-6735
Mailing Address - Fax:
Practice Address - Street 1:3610 N ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2599
Practice Address - Country:US
Practice Address - Phone:336-674-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9814101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional