Provider Demographics
NPI:1164163655
Name:MILLS, DOMINIQUE ANTAWN (LPC-R)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ANTAWN
Last Name:MILLS
Suffix:
Gender:M
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5660
Mailing Address - Country:US
Mailing Address - Phone:757-253-0111
Mailing Address - Fax:
Practice Address - Street 1:247 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5660
Practice Address - Country:US
Practice Address - Phone:757-253-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709024174101YA0400X
VA0704014275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)