Healthcare Provider Details

I. General information

NPI: 1003239575
Provider Name (Legal Business Name): KRISTINA MILLS-GREGORY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 VINEYARD DR
CAMDEN NC
27921-7649
US

IV. Provider business mailing address

113 VINEYARD DR
CAMDEN NC
27921-7649
US

V. Phone/Fax

Practice location:
  • Phone: 919-921-6684
  • Fax:
Mailing address:
  • Phone: 919-921-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA8465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: