Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003174079 |
---|---|
Provider Name | Jaclyn Mcmillan |
First Address | Fayetteville, AR 72703-5285 |
Second Address | Fayetteville, AR 72703-4714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2012 |
Last Update Date | 27/04/2012 |