Healthcare Provider Details

I. General information

NPI: 1336497791
Provider Name (Legal Business Name): AISHA RESHA MITCHELL WASHINGTON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. AISHA RESHA MITCHELL

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 GREENCOVE CT
NEWNAN GA
30265-3391
US

IV. Provider business mailing address

90F GLENDA TRCE # 306
NEWNAN GA
30265-3858
US

V. Phone/Fax

Practice location:
  • Phone: 334-782-2743
  • Fax:
Mailing address:
  • Phone: 762-499-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2451C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: