1891097440 NPI number — MRS. VANESSA LYNNE MITCHELL LMSW, ACSW, MAC

Table of content: MRS. VANESSA LYNNE MITCHELL LMSW, ACSW, MAC (NPI 1891097440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891097440 NPI number — MRS. VANESSA LYNNE MITCHELL LMSW, ACSW, MAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
VANESSA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, ACSW, MAC
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:
1891097440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 450
Provider Second Line Business Mailing Address:
BOX 402
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96206-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
0118227066726
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 450
Provider Second Line Business Practice Location Address:
BOX 402
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96206-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
0118227066726
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2010

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: 101YA0400X , with the licence number:  24620 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801087485 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24620 . This is a "NATIONAL ASSOCIATION OF FORENIC COUNSELORS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 6801087485 . This is a "STATE OF MICHIGAN DEPT OF COMMUNITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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