1750778007 NPI number — MRS. PRINCESS MITCHELL LCMHC-A

Table of content: MRS. PRINCESS MITCHELL LCMHC-A (NPI 1750778007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750778007 NPI number — MRS. PRINCESS MITCHELL LCMHC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
PRINCESS
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750778007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 CHERRY LAUREL DR APT 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28314-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-736-9111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 SPRING FOREST RD STE 800
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27609-9130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-418-1718
Provider Business Practice Location Address Fax Number:
919-794-5715
Provider Enumeration Date:
04/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com