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General NPI Number Information
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NPI Number | 1306897947
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Entity Type | Individual
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Provider Name | MATTHEW DAIL MCMILLAN MS,LCAS, LCMHC, CCS
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 822 N ELM ST STE 109
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City | GREENSBORO
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State | NC
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Zip | 27401-1538
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Country | US
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Telephone | 336-329-8506
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Fax | 336-510-4434
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Provider Business Mailing Address
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Address Line | 2618 BATTLEGROUND AVE #321
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City | GREENSBORO
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State | NC
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Zip | 27408-1925
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Country | US
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Telephone | 336-329-8506
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Fax | 336-510-4434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 535
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2489
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License Number State | NC
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