Provider Demographics
NPI:1992015317
Name:MILLS, TAKEYA DANIELL (LLBSW)
Entity Type:Individual
Prefix:MS
First Name:TAKEYA
Middle Name:DANIELL
Last Name:MILLS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27400 FRANKLIN RD
Mailing Address - Street 2:APT # 600
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2358
Mailing Address - Country:US
Mailing Address - Phone:313-720-2170
Mailing Address - Fax:
Practice Address - Street 1:44899 CENTRE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5510
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL18568011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical