Healthcare Provider Details

I. General information

NPI: 1700203536
Provider Name (Legal Business Name): PHILIP MITCHELL L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 SHARON RD STE 201
KING WILLIAM VA
23086-3347
US

IV. Provider business mailing address

300 S 11TH ST APT 3121
RICHMOND VA
23219-1942
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-2751
  • Fax: 804-769-3125
Mailing address:
  • Phone: 757-775-5814
  • Fax: 804-695-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005707
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: