Healthcare Provider Details

I. General information

NPI: 1518686732
Provider Name (Legal Business Name): CHANDA HALL MITCHELL MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W NC HIGHWAY 54 STE 403
DURHAM NC
27707-5599
US

IV. Provider business mailing address

934 CHANNING PARK CIR
CARY NC
27519-7636
US

V. Phone/Fax

Practice location:
  • Phone: 919-418-1718
  • Fax:
Mailing address:
  • Phone: 252-315-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP015839
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: