Provider Demographics
NPI:1114020476
Name:MILLS, NANCY CAROLE (MA, CAC-I)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CAROLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:MA, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HUSTON DR.
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746
Mailing Address - Country:US
Mailing Address - Phone:989-871-9542
Mailing Address - Fax:
Practice Address - Street 1:400 STODDARD RD.
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041-4103
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:810-392-2057
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI#500044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)