Individual
MRS. JACQUELINE MCMILLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5302 SLATER AVE., FAYETTEVILLE, NC 28301
(910) 488-6130
Mailing address
PO BOX 26102, FAYETTEVILLE, NC 28314-5018
(910) 583-4172
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
7805049
NC
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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