Provider Demographics
NPI:1386943314
Name:MILLISON, JEFF BRETT (MAC, LAC)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:BRETT
Last Name:MILLISON
Suffix:
Gender:M
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4801 DORSEY HALL DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7766
Mailing Address - Country:US
Mailing Address - Phone:410-715-0200
Mailing Address - Fax:410-715-4696
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 212
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:410-715-0200
Practice Address - Fax:410-715-4696
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDU00396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist