Healthcare Provider Details

I. General information

NPI: 1508034299
Provider Name (Legal Business Name): LINDA L MITCHELL MA. LPC CAC1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MILITARY ST
PORT HURON MI
48060-5416
US

IV. Provider business mailing address

3798 CASEY RD
METAMORA MI
48455-9317
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-5437
  • Fax: 810-985-9011
Mailing address:
  • Phone: 810-796-2064
  • Fax: 810-496-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: