Provider Demographics
NPI:1366140683
Name:MCMILLIAN, DIAMOND SHARELLE (LCSW)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:SHARELLE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 21ST ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2402
Mailing Address - Country:US
Mailing Address - Phone:415-515-5550
Mailing Address - Fax:
Practice Address - Street 1:2830 21ST ST APT 8
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-2402
Practice Address - Country:US
Practice Address - Phone:415-515-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1128811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical