Provider Demographics
NPI:1902108137
Name:MITCHELL, LUCIA ISAC (RD)
Entity Type:Individual
Prefix:MRS
First Name:LUCIA
Middle Name:ISAC
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 FETTLER PARK
Mailing Address - Street 2:DUMFRIES HEALTH CENTER
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025
Mailing Address - Country:US
Mailing Address - Phone:703-441-7500
Mailing Address - Fax:
Practice Address - Street 1:700 FETTLER PARK
Practice Address - Street 2:DUMFRIES HEALTH CENTER
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025
Practice Address - Country:US
Practice Address - Phone:703-441-7500
Practice Address - Fax:202-269-7484
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD1100000386133V00000X
DC1040898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1040898OtherREGISTER DIETITIAN (RD)
DCD1100000386OtherDIETITIAN LICENSE