Provider Demographics
NPI:1447030077
Name:MILLS, TANYA DIONNE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:DIONNE
Last Name:MILLS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:COSTON BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 KENMORE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5792
Mailing Address - Country:US
Mailing Address - Phone:540-632-4002
Mailing Address - Fax:
Practice Address - Street 1:701 KENMORE AVE STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5792
Practice Address - Country:US
Practice Address - Phone:757-635-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040170321041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical