Provider Demographics
NPI:1992446355
Name:MITCHEM, NATALIE (BCBA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6311
Mailing Address - Country:US
Mailing Address - Phone:252-341-4192
Mailing Address - Fax:
Practice Address - Street 1:1116 20TH STREET SOUTH, 35205
Practice Address - Street 2:PMB# 51
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2612
Practice Address - Country:US
Practice Address - Phone:205-490-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-25-81187103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician