Provider Demographics
NPI:1265904437
Name:MCMILLIAN, VERONICA DAVIS (MA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:DAVIS
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 ROKEBY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2228
Mailing Address - Country:US
Mailing Address - Phone:757-572-0974
Mailing Address - Fax:
Practice Address - Street 1:1712 ROKEBY AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2228
Practice Address - Country:US
Practice Address - Phone:757-572-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101Y0000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator