Provider Demographics
NPI:1730373184
Name:MILLS FAMILY CARE
Entity type:Organization
Organization Name:MILLS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEVON
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:252-527-2367
Mailing Address - Street 1:916 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1532
Mailing Address - Country:US
Mailing Address - Phone:252-527-5367
Mailing Address - Fax:
Practice Address - Street 1:450 SOMMERSET DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5658
Practice Address - Country:US
Practice Address - Phone:919-934-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty