Healthcare Provider Details

I. General information

NPI: 1194254276
Provider Name (Legal Business Name): KATHRYN AUGUSTE MITCHELL LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FOWLER RD
CAPE ELIZABETH ME
04107-2408
US

IV. Provider business mailing address

57 VINCENT ST
SOUTH PORTLAND ME
04106-3951
US

V. Phone/Fax

Practice location:
  • Phone: 603-660-2369
  • Fax:
Mailing address:
  • Phone: 603-660-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5275
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: