Provider Demographics
NPI:1548954159
Name:MITCHELL, BRANDON (RBT)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1119
Mailing Address - Country:US
Mailing Address - Phone:540-523-8099
Mailing Address - Fax:540-400-8808
Practice Address - Street 1:1700 TURNER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-6941
Practice Address - Country:US
Practice Address - Phone:804-523-6202
Practice Address - Fax:804-447-4669
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT21-164782106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician