# AUTHENTIC SELF ASSOCIATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720854466
- **Authorized official:** MR. COTY A MILLS LCSW, CSAC, MSW, BSW (OWNER/THERAPIST)
- **Authorized official phone:** (757) 918-3381

## Contact information

- **Practice address:** 4404 EAGLEBROOK DR, WILLIAMSBURG, VA 23188-8038
- **Practice address phone:** (757) 918-3381
- **Mailing address:** 4404 EAGLEBROOK DR, WILLIAMSBURG, VA 23188-8038
- **Mailing address phone:** (757) 918-3381

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2023
- **Last updated:** 12/04/2023