Provider Demographics
NPI:1750768529
Name:MILLS, NANCY (MS, LAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-5954
Mailing Address - Country:US
Mailing Address - Phone:856-378-7964
Mailing Address - Fax:
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-696-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00095800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional