Provider Demographics
NPI:1376950741
Name:MILLS, FREIDA (LMBT #9918)
Entity Type:Individual
Prefix:
First Name:FREIDA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMBT #9918
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 KERNERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8106
Mailing Address - Country:US
Mailing Address - Phone:336-302-3673
Mailing Address - Fax:
Practice Address - Street 1:831A SEDGE GARDEN RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7510
Practice Address - Country:US
Practice Address - Phone:336-310-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist