Healthcare Provider Details

I. General information

NPI: 1871011247
Provider Name (Legal Business Name): MRS. SHEILA MARIE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RELAY RD
ANGOON AK
99820
US

IV. Provider business mailing address

714 AANDEINAAT STREET
ANGOON AK
99820
US

V. Phone/Fax

Practice location:
  • Phone: 907-788-4600
  • Fax: 907-788-3180
Mailing address:
  • Phone: 907-500-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: