Healthcare Provider Details

I. General information

NPI: 1316207558
Provider Name (Legal Business Name): PENNY MARIE MITCHELL LPC05951
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MIDWAY DR, UNIT C
WINFIELD AL
35594-0931
US

IV. Provider business mailing address

326 GOLDENWOOD DR
HAMILTON AL
35570-3571
US

V. Phone/Fax

Practice location:
  • Phone: 877-211-2882
  • Fax: 205-449-0049
Mailing address:
  • Phone: 205-570-8233
  • Fax: 205-449-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05951
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: