Provider Demographics
NPI:1225222706
Name:MILLS, JESSICA (MS ED)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6316 SAN JUAN AVE STE 41
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2883
Mailing Address - Country:US
Mailing Address - Phone:904-783-2579
Mailing Address - Fax:904-783-1901
Practice Address - Street 1:6316 SAN JUAN AVE STE 41
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2883
Practice Address - Country:US
Practice Address - Phone:904-783-2579
Practice Address - Fax:904-783-1901
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health