Provider Demographics
NPI:1871540807
Name:EIKON PROFESSIONAL SERVICES
Entity type:Organization
Organization Name:EIKON PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-317-4702
Mailing Address - Street 1:8238 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1832
Mailing Address - Country:US
Mailing Address - Phone:301-317-8982
Mailing Address - Fax:301-497-9493
Practice Address - Street 1:9811 MALLARD DR
Practice Address - Street 2:SUITE 219
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3143
Practice Address - Country:US
Practice Address - Phone:301-317-4702
Practice Address - Fax:301-497-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD744BEIOtherBLUE CROSS & BLUE SHIELD