Provider Demographics
NPI:1619399672
Name:GINA M. MILLS, LCSW, LLC
Entity Type:Organization
Organization Name:GINA M. MILLS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-516-5672
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0080
Mailing Address - Country:US
Mailing Address - Phone:860-516-5672
Mailing Address - Fax:888-233-4694
Practice Address - Street 1:329 LEDGE RD
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-1923
Practice Address - Country:US
Practice Address - Phone:860-516-5672
Practice Address - Fax:888-233-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT83871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty