Provider Demographics
NPI:1528715356
Name:MILLINER, EVENNY
Entity type:Individual
Prefix:
First Name:EVENNY
Middle Name:
Last Name:MILLINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 FORBES BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4469
Mailing Address - Country:US
Mailing Address - Phone:443-272-5939
Mailing Address - Fax:
Practice Address - Street 1:3815 FORT DR NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1870
Practice Address - Country:US
Practice Address - Phone:888-878-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27917104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker