Provider Demographics
NPI:1366604886
Name:MILAM, DAVID NATHAN (LAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NATHAN
Last Name:MILAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:214 CHIMNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8555
Mailing Address - Country:US
Mailing Address - Phone:318-372-9050
Mailing Address - Fax:318-396-9040
Practice Address - Street 1:214 CHIMNEY HILL RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-8555
Practice Address - Country:US
Practice Address - Phone:318-372-9050
Practice Address - Fax:318-396-9040
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)