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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

Details

NameValue
NPI1447783097
Enumeration Date2017-04-10
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthNC20437
No 101YM0800X - Counselor - Mental Health