1700966272 NPI number — MISS VALERIE MICHELLE MITCHELL LMSW

Table of content: MISS VALERIE MICHELLE MITCHELL LMSW (NPI 1700966272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700966272 NPI number — MISS VALERIE MICHELLE MITCHELL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
VALERIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1700966272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 GEESLIN ROAD
Provider Second Line Business Mailing Address:
LOT 5
Provider Business Mailing Address City Name:
GRENADA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-289-1800
Provider Business Mailing Address Fax Number:
662-289-9770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 HIGHWAY 12 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOSCIUSKO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39090-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-289-1800
Provider Business Practice Location Address Fax Number:
662-289-9770
Provider Enumeration Date:
10/17/2006

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 , with the licence number:  M6205 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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