Healthcare Provider Details

I. General information

NPI: 1235741935
Provider Name (Legal Business Name): JOSEPH MILLS LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BLAINE ST NE
WASHINGTON DC
20019-6665
US

IV. Provider business mailing address

9104 MONTPELIER DR
LAUREL MD
20708-2550
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-6811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLG50083330
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: