Provider Demographics
NPI:1790151595
Name:SINGH, CARLY MILLS (MA, PCCI)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MILLS
Last Name:SINGH
Suffix:
Gender:F
Credentials:MA, PCCI
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ELLEN
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 JONES ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 JONES ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5414
Practice Address - Country:US
Practice Address - Phone:678-296-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health