Healthcare Provider Details

I. General information

NPI: 1649786609
Provider Name (Legal Business Name): DEBORAH L MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 C CT
ASHTABULA OH
44004-4577
US

IV. Provider business mailing address

38882 MENTOR AVE
WILLOUGHBY OH
44094-7875
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-0722
  • Fax:
Mailing address:
  • Phone: 440-953-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: