Provider Demographics
NPI:1922810209
Name:MCMILLIAN, KERSTIN ANN (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:KERSTIN
Middle Name:ANN
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20311 CHARTWELL DRIVE
Mailing Address - Street 2:1052
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8807 THORNBURY LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8517
Practice Address - Country:US
Practice Address - Phone:503-347-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health