Provider Demographics
NPI:1265719322
Name:MCMILLIAN, THOMAS LOUIS JR (MSW, DA, LPC -LCAS-A)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LOUIS
Last Name:MCMILLIAN
Suffix:JR
Gender:M
Credentials:MSW, DA, LPC -LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 DORA LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7688
Mailing Address - Country:US
Mailing Address - Phone:910-797-2149
Mailing Address - Fax:
Practice Address - Street 1:6885 CLIFFDALE RD STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2834
Practice Address - Country:US
Practice Address - Phone:910-339-0400
Practice Address - Fax:910-339-0396
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2534-A101YA0400X
NC9000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)