Provider Demographics
NPI:1528439981
Name:MCMILLIAN, SHALAYNE LINDA (LSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:SHALAYNE
Middle Name:LINDA
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:LSW, CADC
Other - Prefix:
Other - First Name:SHALAYNE
Other - Middle Name:LINDA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, CADC
Mailing Address - Street 1:675 N NORTH CT STE 250
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8190
Mailing Address - Country:US
Mailing Address - Phone:847-530-0484
Mailing Address - Fax:
Practice Address - Street 1:675 N NORTH CT STE 250
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8190
Practice Address - Country:US
Practice Address - Phone:847-530-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)