Provider Demographics
NPI:1447783097
Name:MILLS, JASON MATTHEW (LCMHC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MATTHEW
Last Name:MILLS
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 GATEWAY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5544
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:980-939-8769
Practice Address - Street 1:2000 REGENCY PKWY STE 255
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8511
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:980-939-8769
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20437101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health