Provider Demographics
NPI:1447309646
Name:MILLMAN, ERIC BRUCE (LGPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BRUCE
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHURCH LN STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3839
Mailing Address - Country:US
Mailing Address - Phone:410-343-9756
Mailing Address - Fax:
Practice Address - Street 1:104 CHURCH LN STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3839
Practice Address - Country:US
Practice Address - Phone:410-343-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP302101YP2500X
MDLC3449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional