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General NPI Number Information
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NPI Number | 1619033701
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Entity Type | Individual
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Provider Name | CHARLES CRAIG MILLS MC
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Gender | Male
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Dates
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Enumeration Date | 12/31/2006
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 4222 E CAMELBACK RD SUITE 230H
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City | PHOENIX
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State | AZ
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Zip | 85018-2745
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Country | US
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Telephone | 602-852-0911
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Fax | 602-852-0632
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Provider Business Mailing Address
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Address Line | 1261 W. LYNX WAY
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City | CHANDLER
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State | AZ
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Zip | 85248
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Country | US
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Telephone | 602-852-0911
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Fax | 602-852-0632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-0245
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License Number State | AZ
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