Provider Information for 1447783097
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Mr. JASON MATTHEW MILLS LCMHC
Sex: Male
NPI: 1447783097
Last Updated: 2024-09-03
Certification Date: 2024-09-03
Certification Date: 2024-09-03
Details
Name | Value | ||||||||||||
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NPI | 1447783097 | ||||||||||||
Enumeration Date | 2017-04-10 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 122 GATEWAY BLVD STE C MOORESVILLE, NC 28117-5544 United States Phone: 704-360-3637 | Fax:980-939-8769 | ||||||||||||
Primary Practice Address | 2000 REGENCY PKWY STE 255 CARY, NC 27518-8511 United States Phone: 704-360-3637 | Fax:980-939-8769 | ||||||||||||
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