Most Relevant Information
Provider Data
| NPI Number: | 1003599879 |
| Provider Name: | MIRIAM MACKILLOP LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 0701005346 |
Most Important Dates
| Enumeration Date: | 08/09/2023 |
| Last Updated: | 08/09/2023 |
Provider Practice Location
9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER
VA
230614162
Practice Location Phone/Fax
| Phone: | 8046958120 |
| Fax: | 8046958122 |
Provider Mailing Location
9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER
VA
230614162
Provider Mailing Phone/Fax
| Phone: | 8046958120 |
| Fax: | 8046958122 |