Healthcare Provider Details

I. General information

NPI: 1346298320
Provider Name (Legal Business Name): DENISE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 LLOYD ST STE 230
CARRBORO NC
27510-1855
US

IV. Provider business mailing address

1305 INDIAN CAMP RD
CHAPEL HILL NC
27516-8844
US

V. Phone/Fax

Practice location:
  • Phone: 919-960-7711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC003889
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: