Healthcare Provider Details

I. General information

NPI: 1134226566
Provider Name (Legal Business Name): VERNON L MILLS SR. LAC/CCS/CCDP-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 RAINBOW DR UNIT 35
PINEVILLE LA
71360-6979
US

IV. Provider business mailing address

3804 SPENCER ST
ALEXANDRIA LA
71302-2242
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-6772
  • Fax: 318-487-5703
Mailing address:
  • Phone: 318-484-3913
  • Fax: 318-484-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC # 713
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCDP-D #1101
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCCS # 017
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: