Healthcare Provider Details

I. General information

NPI: 1629405733
Provider Name (Legal Business Name): SHERETTA SHREE MITCHELL M.S.,LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 W MEADOWVIEW RD SUITE 204
GREENSBORO NC
27407-3406
US

IV. Provider business mailing address

2216 W MEADOWVIEW RD SUITE 204
GREENSBORO NC
27407-3406
US

V. Phone/Fax

Practice location:
  • Phone: 336-854-2655
  • Fax: 336-791-2188
Mailing address:
  • Phone: 336-854-2655
  • Fax: 336-791-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3409-A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: