Healthcare Provider Details

I. General information

NPI: 1225343718
Provider Name (Legal Business Name): MONICA LYNN MCMILLIAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 KANAWHA BLVD E SUITE 900
CHARLESTON WV
25301-2841
US

IV. Provider business mailing address

1018 KANAWHA BLVD E SUITE 900
CHARLESTON WV
25301-2841
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-1060
  • Fax: 304-720-0290
Mailing address:
  • Phone: 304-720-1060
  • Fax: 304-720-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1000
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1000
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1000
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1000
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1000
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1000
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: