Healthcare Provider Details

I. General information

NPI: 1679328629
Provider Name (Legal Business Name): MITCHELL HUTCHISON LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 CHAPEL HILL RD STE H
RALEIGH NC
27607-5039
US

IV. Provider business mailing address

5425 NEUSE FOREST RD
RALEIGH NC
27616-8023
US

V. Phone/Fax

Practice location:
  • Phone: 919-228-8423
  • Fax:
Mailing address:
  • Phone: 318-880-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20181A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: