Healthcare Provider Details

I. General information

NPI: 1962909713
Provider Name (Legal Business Name): JACQUELYN ELEASE MITCHELL BELL LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MARKET ST STE 4
WILMINGTON NC
28403-1426
US

IV. Provider business mailing address

3825 MARKET ST STE 4
WILMINGTON NC
28403-1426
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-5575
  • Fax: 910-777-5273
Mailing address:
  • Phone: 910-777-5575
  • Fax: 910-777-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13721
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13721
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: