Healthcare Provider Details

I. General information

NPI: 1184812307
Provider Name (Legal Business Name): LEAH MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 PALM AVE STE 212
LA MESA CA
91941-5244
US

IV. Provider business mailing address

8697 LA MESA BLVD SUITE C #151
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-7835
  • Fax: 619-463-9824
Mailing address:
  • Phone: 619-289-7835
  • Fax: 619-463-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: