Healthcare Provider Details

I. General information

NPI: 1649182163
Provider Name (Legal Business Name): DOROTHY MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MEADOW HEIGHTS PROFESSIONAL PARK
COLLINSVILLE IL
62234-4471
US

IV. Provider business mailing address

6 MEADOW HEIGHTS PROFESSIONAL PARK
COLLINSVILLE IL
62234-4471
US

V. Phone/Fax

Practice location:
  • Phone: 618-493-2631
  • Fax:
Mailing address:
  • Phone: 618-493-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: