Provider Demographics
NPI:1538401401
Name:MITCHELL, NICOLE LYN (LADC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 DARTMOUTH COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVERHILL
Mailing Address - State:NH
Mailing Address - Zip Code:03774-4909
Mailing Address - Country:US
Mailing Address - Phone:603-787-2042
Mailing Address - Fax:603-787-2044
Practice Address - Street 1:3801 DARTMOUTH COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:NORTH HAVERHILL
Practice Address - State:NH
Practice Address - Zip Code:03774-4909
Practice Address - Country:US
Practice Address - Phone:603-787-2042
Practice Address - Fax:603-787-2044
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0127661101YA0400X
NH0899101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)