Provider Demographics
NPI:1801322904
Name:MITCHELL, DENISE LOUISE (LCPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LOUISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 GORMAN AVENUE
Mailing Address - Street 2:APT. 211
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:443-546-7858
Mailing Address - Fax:
Practice Address - Street 1:8120 GORMAN AVE
Practice Address - Street 2:APT. 211
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3564
Practice Address - Country:US
Practice Address - Phone:443-546-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional