Healthcare Provider Details

I. General information

NPI: 1871403980
Provider Name (Legal Business Name): RACHAEL MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S MAIN ST
STATESBORO GA
30458-5245
US

IV. Provider business mailing address

PO BOX 1242
STATESBORO GA
30459-1242
US

V. Phone/Fax

Practice location:
  • Phone: 912-225-3769
  • Fax: 888-241-9172
Mailing address:
  • Phone: 912-225-3769
  • Fax: 888-241-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: