Healthcare Provider Details

I. General information

NPI: 1235778879
Provider Name (Legal Business Name): SELINA-QUINNETTE MILLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 CEDAR LAKE RD APT 1518
BILOXI MS
39532-4665
US

IV. Provider business mailing address

831 CEDAR LAKE RD APT 1518
BILOXI MS
39532-4665
US

V. Phone/Fax

Practice location:
  • Phone: 910-524-0204
  • Fax:
Mailing address:
  • Phone: 910-524-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA17861
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: