Healthcare Provider Details

I. General information

NPI: 1023252889
Provider Name (Legal Business Name): NANCY MILLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 FLORIDA AVE
PANAMA CITY FL
32401-6311
US

IV. Provider business mailing address

1700 NEW HAMPSHIRE AVE
LYNN HAVEN FL
32444-4118
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-6001
  • Fax: 850-769-6003
Mailing address:
  • Phone: 850-814-8984
  • Fax: 850-248-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: