Provider Demographics
NPI:1992261903
Name:MILNER, SHANTA (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:SHANTA
Middle Name:
Last Name:MILNER
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:SHANTE
Other - Middle Name:
Other - Last Name:KOLLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:20 CROSSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7142
Mailing Address - Country:US
Mailing Address - Phone:864-293-8123
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSVIEW DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7142
Practice Address - Country:US
Practice Address - Phone:864-293-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3335OtherMEDICARE
SC421504Medicaid