Provider Demographics
NPI:1134757735
Name:MILLS, SUSAN TINGLE (ED S, LPC-S, NCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:TINGLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:ED S, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12592 WINDWORD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4565
Mailing Address - Country:US
Mailing Address - Phone:205-454-5460
Mailing Address - Fax:
Practice Address - Street 1:1470 NORTHBANK PARKWAY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-454-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional