Healthcare Provider Details

I. General information

NPI: 1982989497
Provider Name (Legal Business Name): KARMEN JO MCMILLAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TRUMAN ST APT 207
CROSWELL MI
48422-1162
US

IV. Provider business mailing address

24401 CAPITAL BLVD
CLINTON TOWNSHIP MI
48036-1343
US

V. Phone/Fax

Practice location:
  • Phone: 586-484-4285
  • Fax:
Mailing address:
  • Phone: 586-783-2950
  • Fax: 586-690-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092671
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: