Provider Demographics
NPI:1902233562
Name:MITCHELL, LACRESA ROXANNA (MS)
Entity Type:Individual
Prefix:MS
First Name:LACRESA
Middle Name:ROXANNA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LINDSEY WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7718
Mailing Address - Country:US
Mailing Address - Phone:407-209-5108
Mailing Address - Fax:
Practice Address - Street 1:126 LINDSEY WAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7718
Practice Address - Country:US
Practice Address - Phone:407-209-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health