Provider Demographics
NPI:1841544574
Name:MILLS, KIMBERLY (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 10000
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850-9781
Mailing Address - Country:US
Mailing Address - Phone:340-692-4265
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 10000
Practice Address - Street 2:
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00850-9781
Practice Address - Country:US
Practice Address - Phone:340-692-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-12087103K00000X
VA1-12-12087103K00000X
MD1-12-12087103K00000X
DC1-12-12087103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst