Healthcare Provider Details

I. General information

NPI: 1871394049
Provider Name (Legal Business Name): JAIDE ELIZABETH MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAIDE PREWITT

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 WALDEN DR
KINSEY AL
36303
US

IV. Provider business mailing address

6970 WALDEN DR
DOTHAN AL
36303-7555
US

V. Phone/Fax

Practice location:
  • Phone: 334-389-4070
  • Fax:
Mailing address:
  • Phone: 928-830-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: