Provider Demographics
NPI:1003239575
Name:MILLS-GREGORY, KRISTINA (LPCA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MILLS-GREGORY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ANGIE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8936
Mailing Address - Country:US
Mailing Address - Phone:919-689-3346
Mailing Address - Fax:
Practice Address - Street 1:1400 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4510
Practice Address - Country:US
Practice Address - Phone:252-331-0322
Practice Address - Fax:252-331-0320
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health