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General NPI Number Information
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NPI Number | 1477984458
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Entity Type | Organization
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Legal Business Name | MARDI MILLS LCSW LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 1601 116TH AVE NE SUITE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-3010
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Country | US
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Telephone | 425-453-2818
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 116TH AVE NE SUITE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-3010
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Country | US
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Telephone | 425-453-2818
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MARDI MILLS
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Credential | MSW
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Telephone | 425-453-2818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00004117
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License Number State | WA
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