Provider Demographics
NPI:1619033701
Name:MILLS, CHARLES CRAIG (MC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CRAIG
Last Name:MILLS
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 W. LYNX WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248
Mailing Address - Country:US
Mailing Address - Phone:602-852-0911
Mailing Address - Fax:602-852-0632
Practice Address - Street 1:4222 E CAMELBACK RD
Practice Address - Street 2:SUITE 230H
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2745
Practice Address - Country:US
Practice Address - Phone:602-852-0911
Practice Address - Fax:602-852-0632
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional