Provider Demographics
NPI:1881807568
Name:MILLS, JOHN EDWIN (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWIN
Last Name:MILLS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 OWEN PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2807
Mailing Address - Country:US
Mailing Address - Phone:202-390-8157
Mailing Address - Fax:
Practice Address - Street 1:2009 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4725
Practice Address - Country:US
Practice Address - Phone:202-396-4440
Practice Address - Fax:202-396-7505
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3006661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC22822OtherCHARTERED HEALTHCARE