Provider Demographics
NPI:1134226566
Name:MILLS, VERNON L SR (LAC/CCS/CCDP-D)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:L
Last Name:MILLS
Suffix:SR
Gender:M
Credentials:LAC/CCS/CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-2242
Mailing Address - Country:US
Mailing Address - Phone:318-484-3913
Mailing Address - Fax:318-484-3913
Practice Address - Street 1:401 RAINBOW DR UNIT 35
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6979
Practice Address - Country:US
Practice Address - Phone:318-484-6772
Practice Address - Fax:318-487-5703
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALAC # 713101YA0400X
LACCDP-D #1101101YM0800X
LACCS # 017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor