Healthcare Provider Details

I. General information

NPI: 1053527945
Provider Name (Legal Business Name): LEAH CAROL MCMILLAN DPA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 OLD US HIGHWAY 41 N STE A
VALDOSTA GA
31602-6865
US

IV. Provider business mailing address

3790 OLD US HIGHWAY 41 N STE A
VALDOSTA GA
31602-6865
US

V. Phone/Fax

Practice location:
  • Phone: 229-262-1000
  • Fax:
Mailing address:
  • Phone: 229-262-1000
  • Fax: 229-262-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: