Provider Demographics
NPI:1053527945
Name:MCMILLAN, LEAH CAROL (DPA, LMFT)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:CAROL
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:DPA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-244-9688
Mailing Address - Fax:229-244-5354
Practice Address - Street 1:3790 OLD US HIGHWAY 41 N STE A
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6865
Practice Address - Country:US
Practice Address - Phone:229-262-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist