Provider Demographics
NPI:1598597189
Name:MILLS, KAITLIN A
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SEMINARY RD APT 1515
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2023
Mailing Address - Country:US
Mailing Address - Phone:706-588-7319
Mailing Address - Fax:
Practice Address - Street 1:1375 MOUNT OLIVET RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2509
Practice Address - Country:US
Practice Address - Phone:202-739-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2000026991041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool