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NPI Code Detail

MEDICARE: DR. THOMAS LOUIS MCMILLIAN JR. MSW, DA, LPC -LCAS-A

MEDICARE: DR. THOMAS LOUIS MCMILLIAN JR. MSW, DA, LPC -LCAS-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor2534-ANC
2101YP2500XProfessional Counselor9000NC

General Provider Information

NPI Number : 1265719322
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS LOUIS MCMILLIAN JR. MSW, DA, LPC -LCAS-A
Provider Business Mailing Address
First Line : 307 DORA LN
Second Line :
City : RAEFORD
State : NC
Zip : 28376-7688
Country : US
Telephone Number : 910-797-2149
Fax Number :
Provider Business Practice Location Address
First Line : 6885 CLIFFDALE RD STE 202
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-2834
Country : US
Telephone Number : 910-339-0400
Fax Number : 910-339-0396
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2011
Last Update Date : 06/09/2020

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