Healthcare Provider Details

I. General information

NPI: 1780340877
Provider Name (Legal Business Name): TERESA DANIELLE MCMILLIN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

IV. Provider business mailing address

2627 CHARLESTOWN RD
NEW ALBANY IN
47150-2536
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99106963A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: