Healthcare Provider Details

I. General information

NPI: 1881281566
Provider Name (Legal Business Name): ASHLEY S MILLS BACHLOR OF SCIENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 2ND AVE
CHARLESTON WV
25387-2514
US

IV. Provider business mailing address

1607 W DUPONT AVE APT 16
BELLE WV
25015-1236
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0586
  • Fax:
Mailing address:
  • Phone: 304-941-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: