Doctor Name: | MR. RICKY DONALD MITCHELL |
NPI Number: | 1457556011 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CSAC, LPC |
License Number: | 0701003539 |
Business Practice Address: | 165 Grannys Rd Pounding Mill, VA - 246374025 |
Business Phone Number: | 2769633606 |
Business Fax Number: | 2769633747 |
Mailing Address: | 80 Woodbriar St., LEBANON |
State: | VA |
Postal Code: | 24266 |
Phone Number: | 2769711488 |
Fax Number: | 2769633747 |
NPI Enumeration Date: | 06/15/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701003539 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |