Healthcare Provider Details

I. General information

NPI: 1134870520
Provider Name (Legal Business Name): RHYAN A MITCHELL LRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 10/13/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL STE 255
ASHBURN VA
20147-3394
US

IV. Provider business mailing address

9202 CENTER OAK CT
MECHANICSVILLE VA
23116-2744
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704009320
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: