Provider Demographics
NPI:1952928095
Name:MILLS, COTY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:COTY
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 EAGLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8038
Mailing Address - Country:US
Mailing Address - Phone:757-918-3381
Mailing Address - Fax:
Practice Address - Street 1:1303 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3021
Practice Address - Country:US
Practice Address - Phone:757-918-3381
Practice Address - Fax:757-578-9119
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040119001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical