Provider Demographics
NPI:1922749696
Name:MILLS, LETICIA MICHELE (LMSW)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:MICHELE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-2436
Mailing Address - Country:US
Mailing Address - Phone:520-870-2381
Mailing Address - Fax:
Practice Address - Street 1:3615 E 24TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-2436
Practice Address - Country:US
Practice Address - Phone:520-870-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AZLMSW-13245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker