Individual
TARIK MALACHI MCMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.ED.
Contact information
Practice address
40 EG LAGRANGE, FREDERIKSTED, VI 00840
(340) 332-2717
Mailing address
PO BOX 1833, FREDERIKSTED, VI 00841-1833
(340) 332-2717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2-43354-1L
VI
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2-43354
DEPARTMENT OF LICENSING AND CONSUMER AFFAIRS
VI
Enumeration date
12/08/2017
Last updated
10/15/2019
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