Provider Demographics
NPI:1346801651
Name:MILLS, SHAMEKA SHONDRECE
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:SHONDRECE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18331 ROSLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4619
Mailing Address - Country:US
Mailing Address - Phone:310-728-0919
Mailing Address - Fax:310-212-1443
Practice Address - Street 1:18331 ROSLIN AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4619
Practice Address - Country:US
Practice Address - Phone:310-728-0919
Practice Address - Fax:310-212-1443
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker