Provider Demographics
NPI:1649872615
Name:MILLS, REBECCA MARIE (JD, LLMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:JD, LLMSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARIE
Other - Last Name:RAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 TROWBRIDGE ST NE APT 208
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1891
Mailing Address - Country:US
Mailing Address - Phone:616-499-7711
Mailing Address - Fax:
Practice Address - Street 1:221 TROWBRIDGE ST NE APT 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1891
Practice Address - Country:US
Practice Address - Phone:616-499-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011024201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical