MEDICARE: ANDREA MITCHELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904005848	VA

General Provider Information

NPI Number	:	1518356773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MITCHELL LCSW

Provider Business Mailing Address
First Line	:	1129 GASKINS RD
Second Line	:	SUITE 107
City	:	RICHMOND
State	:	VA
Zip	:	23238-5235
Country	:	US
Telephone Number	:	804-741-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 GASKINS RD
Second Line	:	SUITE 107
City	:	RICHMOND
State	:	VA
Zip	:	23238-5235
Country	:	US
Telephone Number	:	804-741-2333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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