Doctor Name: | MRS. JACQUELINE MCMILLIAN |
NPI Number: | 1477676500 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 7805049 |
Business Practice Address: | 5302 Slater Ave. Fayetteville, NC - 28301 |
Business Phone Number: | 9104886130 |
Business Fax Number: | |
Mailing Address: | Po Box 26102, FAYETTEVILLE |
State: | NC |
Postal Code: | 283145018 |
Phone Number: | 9105834172 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 7805049 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |