Provider Demographics
NPI:1588194336
Name:MILLS, JAMES FITZGERALD (CIT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FITZGERALD
Last Name:MILLS
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-0580
Mailing Address - Country:US
Mailing Address - Phone:337-855-9023
Mailing Address - Fax:337-855-1829
Practice Address - Street 1:21089 SOUTH FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:LACASSINE
Practice Address - State:LA
Practice Address - Zip Code:70650
Practice Address - Country:US
Practice Address - Phone:337-936-9197
Practice Address - Fax:337-855-1829
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)