Provider Demographics
NPI:1215512553
Name:MILLSAP, MANDY NASHA' (LMHC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:NASHA'
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 MILLIGAN FORD RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9506
Mailing Address - Country:US
Mailing Address - Phone:251-591-6755
Mailing Address - Fax:
Practice Address - Street 1:5674 MILLIGAN FORD RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-9506
Practice Address - Country:US
Practice Address - Phone:251-591-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health