1083948897 NPI number — MS. SUSAN DANIELLE MACMILLAN L.C.S.W.

Table of content: MS. SUSAN DANIELLE MACMILLAN L.C.S.W. (NPI 1083948897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083948897 NPI number — MS. SUSAN DANIELLE MACMILLAN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
SUSAN
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083948897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2750 OLD ALABAMA RD.
Provider Second Line Business Mailing Address:
S.200 THE SUMMIT COUNSELING CENTER
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-893-6300
Provider Business Mailing Address Fax Number:
678-893-5312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 OLD ALABAMA RD.
Provider Second Line Business Practice Location Address:
S.200 THE SUMMIT COUNSELING CENTER
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-893-6300
Provider Business Practice Location Address Fax Number:
678-893-5312
Provider Enumeration Date:
09/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW002515 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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