Healthcare Provider Details

I. General information

NPI: 1851209605
Provider Name (Legal Business Name): NEVALON MITCHELL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE AVENUE ,NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

12207 BEECHFIELD DR
BOWIE MD
20720-3754
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCACII1286
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: