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Individual

DR. T.STACEY MCMILLAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPT, LMFT, PH.D.

Contact information

Practice address
43 W FRONT ST STE B, KEYPORT, NJ 07735-3601
(732) 407-0006
(732) 518-5032
Mailing address
PO BOX 728, KEYPORT, NJ 07735-0728
(732) 497-0666
(732) 518-5032

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
TM714709D
FL

Other

Enumeration date
11/05/2013
Last updated
11/05/2013
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