Provider Demographics
NPI:1861771404
Name:MILLS, GINA L (EDD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 FAIRGROUNDS RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2468
Mailing Address - Country:US
Mailing Address - Phone:636-724-6880
Mailing Address - Fax:636-724-6933
Practice Address - Street 1:1475 FAIRGROUNDS RD
Practice Address - Street 2:SUITE 128
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2468
Practice Address - Country:US
Practice Address - Phone:636-724-6880
Practice Address - Fax:636-724-6933
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health