Provider Demographics
NPI:1457310443
Name:MILLS, LINDA K (LSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:MILLS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-0787
Mailing Address - Country:US
Mailing Address - Phone:304-253-5793
Mailing Address - Fax:304-253-0166
Practice Address - Street 1:202 BALLENGEE ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2319
Practice Address - Country:US
Practice Address - Phone:304-466-3986
Practice Address - Fax:304-466-4411
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00213519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMISW18834Medicare ID - Type Unspecified