Healthcare Provider Details

I. General information

NPI: 1750208336
Provider Name (Legal Business Name): AMBER MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST RD STE 300
TOWSON MD
21204-2370
US

IV. Provider business mailing address

6388 EDESVILLE RD
ROCK HALL MD
21661-2059
US

V. Phone/Fax

Practice location:
  • Phone: 667-824-2779
  • Fax:
Mailing address:
  • Phone: 877-630-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: