Doctor Name: | MILLICENT SELF |
NPI Number: | 1356566780 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 2247 |
Business Practice Address: | 16 Maritime Dr. Surf City, NC - 28445 |
Business Phone Number: | 9103282624 |
Business Fax Number: | |
Mailing Address: | Po Box 3561, TOPSAIL BEACH |
State: | NC |
Postal Code: | 284459831 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/13/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |