Provider Demographics
NPI:1043866536
Name:MCMILLIN, KATRINA (LMSW)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MCMILLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2449 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:361 TOWNE CENTER PL STE 1300
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4866
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker