Provider Demographics
NPI:1336901800
Name:MILLS, KELLYE MARIE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GOLD MILL PL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-4025
Mailing Address - Country:US
Mailing Address - Phone:678-481-3315
Mailing Address - Fax:
Practice Address - Street 1:135 GOLD MILL PL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-4025
Practice Address - Country:US
Practice Address - Phone:678-644-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional