Provider Demographics
NPI:1558404699
Name:MILLS, SONIA (PHD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 192ND ARMORED TANK BN RD
Mailing Address - Street 2:BUILDING 853
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121
Mailing Address - Country:US
Mailing Address - Phone:502-624-3506
Mailing Address - Fax:
Practice Address - Street 1:433 192ND ARMORED TANK BN RD
Practice Address - Street 2:BUILDING 853
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-3506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042277A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical