Provider Demographics
NPI:1790344489
Name:MILLS, VIELKA HAYDEE (EDD)
Entity Type:Individual
Prefix:DR
First Name:VIELKA
Middle Name:HAYDEE
Last Name:MILLS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:VIELKA
Other - Middle Name:HAYDEE
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:1388 ROYAL DORNOCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-4113
Mailing Address - Country:US
Mailing Address - Phone:904-382-6109
Mailing Address - Fax:
Practice Address - Street 1:7019 MARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4889
Practice Address - Country:US
Practice Address - Phone:904-382-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty